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DSH100038G MEMORIAL REGIONAL HOSPITAL (Active)
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Main Details
Name
MEMORIAL REGIONAL HOSPITAL
Subdivision Name
MCI Infusion MRH
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100038G
Medicare Provider Number
100038
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
6/2/2010
Participating Start Date
7/1/2010
Participating Approval Date
6/11/2010
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Memorial Regional Hospital
AURELIO FERNANDEZ, CEO
(954) 265-5014
Primary Contact
Memorial Healthcare System
Alexsandra Soto, Director, 340B Program
(954) 276-1771
Addresses
Street Address
1150 North 35th AVE
SUITE #270
HOLLYWOOD, FL 33021
Billing Address
Memorial Healthcare System
PO Box 269001
Attn: Accounts Payable
Pembroke Pines, FL 33026
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/7/2010- AMDP- NETWORK- SOUTH BROWARD HOSPITAL DISTRICT; 12/18/09 AMDP APPROVED ON 10/15/09
06/18/2010
4/7/2010- AMDP- NETWORK- SOUTH BROWARD HOSPITAL DISTRICT; 12/18/09 AMDP APPROVED ON 10/15/09
06/02/2010
April 2025
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