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DSH100022L JACKSON HEALTH SYSTEM (Active)
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Main Details
Name
JACKSON HEALTH SYSTEM
Subdivision Name
JACKSON SOUTH COMMUNITY HOSPITAL
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100022L
Medicare Provider Number
100022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
9/17/2008
Participating Start Date
9/18/2008
Participating Approval Date
9/18/2008
Last Recertification Date
8/29/2024
Contacts
Authorizing Official
Jackson Health System
Carlos A. Migoya, CEO
(305) 585-6754
Primary Contact
Jackson Health System
VENESSA GOODNOW, AVP & CHIEF PHARMACY OFFICER
(305) 585-7411
Addresses
Street Address
9333 SW 152ND STREET
MIAMI, FL 33157
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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