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DSH100022M JACKSON HEALTH SYSTEM (Active)
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Main Details
Name
JACKSON HEALTH SYSTEM
Subdivision Name
JACKSON NORTH MEDICAL CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100022M
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
160 NW 170 STREET
NORTH MIAMI BEACH, FL 33169
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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