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DSH100281B SOUTH BROWARD HOSPITAL DISTRICT DBA MEMORIAL HOSPITAL WEST (Terminated)
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Main Details
Name
SOUTH BROWARD HOSPITAL DISTRICT DBA MEMORIAL HOSPITAL WEST
Subdivision Name
MEMORIAL WEST CANCER CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100281B
Medicare Provider Number
100281
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
12/11/2007
Participating Start Date
1/1/2008
Participating Approval Date
12/12/2007
Last Recertification Date
8/10/2015
Termination Date
Termination Reason
4/1/2016
Site closure
Contacts
Authorizing Official
Memorial Healthcare System
LEAH CARPENTER, CEO
(954) 844-7500
Primary Contact
Keith Fricker, Director, Pharmacy Contracting
(954) 276-5491
Addresses
Street Address
703 N. FLAMINGO RD.
PEMBROKE PINES, FL 33028
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/7/2010- AMDP- NETWORK- SOUTH BROWARD HOSPITAL DISTRICT; 4/7/08-REVISED TO SHIP-TO ADDRESS (WAS 801 N. FLAMINGO RD.)
12/11/2007
May 2025
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