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DSH100006E ORLANDO HEALTH (Terminated)
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Main Details
Name
ORLANDO HEALTH
Subdivision Name
SOUTH SEMINOLE HOSPITAL
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100006E
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
9/4/2019
Termination Date
Termination Reason
4/1/2020
Other
Contacts
Authorizing Official
orlando health
BERNADETTE SPONG, CFO
(321) 841-5078
Primary Contact
Orlando Health
James Moye II, 340B Program Coordinator
(321) 841-6656
Addresses
Street Address
555 W SR 434
Longwood, FL 32750
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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