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DSH100075A ST JOSEPH'S HOSPITAL (Terminated)
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Main Details
Name
ST JOSEPH'S HOSPITAL
Subdivision Name
ST JOSEPH'S HOSPITAL- NORTH
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100075A
Medicare Provider Number
100075
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
2/11/2010
Participating Start Date
4/1/2010
Participating Approval Date
3/10/2010
Last Recertification Date
8/31/2015
Termination Date
Termination Reason
4/1/2016
Other
Contacts
Authorizing Official
Baycare Health System
Carl Tremonti, Chief Financial Officer
(813) 870-4020
Primary Contact
BayCare Health System
Michael Magee, Vice President of Pharmacy
(813) 870-4020
Addresses
Street Address
4211 VAN DYKE ROAD
LUTZ, FL 33558
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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