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DSH100025AC SACRED HEART HEALTH SYSTEM (Active)
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Main Details
Name
SACRED HEART HEALTH SYSTEM
Subdivision Name
SHMG Primary Care Davis HWY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100025AC
Medicare Provider Number
100025
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
12/6/2010
Participating Start Date
1/1/2011
Participating Approval Date
12/22/2010
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Sacred Heart Health System, Inc.
Susan Cornejo, Chief Operating Officer
(850) 416-6206
Primary Contact
Sacred Heart Health System, Inc.
Troy Russo, 340B Coordinator
(850) 416-2859
Addresses
Street Address
4501 N. DAVIS HIGHWAY
SUITE A
PENSACOLA, FL 32503
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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