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DSH100017 HALIFAX HEALTH MEDICAL CENTER (Active)
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Main Details
Name
HALIFAX HEALTH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100017
Medicare Provider Number
100017
Additional Details
Current Program Status
Active
Registration Date
12/4/2008
Participating Start Date
1/1/2009
Participating Approval Date
12/4/2008
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Halifax Hospital Medical Center
Alberto J Tineo, Chief Operating Officer
(386) 425-4073
Primary Contact
Halifax Health Medical Center
Crystal A Lue, Director, Reimbursement and Revenue
(386) 425-7382
Addresses
Street Address
303 N CLYDE MORRIS BLVD
DAYTONA BEACH, FL 32114
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/30/09 DOC. RECD. TO CONFIRM DSH ADJ. 11/08 DOC RECD TO CONFIRM DSH ADJ%; 2/25/09 REMOVED MEDICAID # (WAS 101842)
03/24/2011
April 2025
April 2025
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