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DSH100006B ORLANDO HEALTH (Terminated)
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Main Details
Name
ORLANDO HEALTH
Subdivision Name
ORLANDO REGIONAL LUCERNE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100006B
Medicare Provider Number
100006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/3/2008
Participating Start Date
4/1/2004
Participating Approval Date
1/3/2008
Last Recertification Date
9/8/2015
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
orlando health
BERNADETTE SPONG, CFO
(321) 841-5078
Primary Contact
RANDY HAYAS, Chief Supply Chain Officer
(321) 841-6732
Addresses
Street Address
818 MAIN LANE
ORLANDO, FL 32801
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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11/19/10 ORLANDO HEALTH(WAS ORLANDO REGIONAL HEALTHCARE)
01/03/2008
April 2025
April 2025
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