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DSH100025AF SACRED HEART HEALTH SYSTEM (Terminated)
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Main Details
Name
SACRED HEART HEALTH SYSTEM
Subdivision Name
SACRED HEART MEDICAL GROUP - NEUROSURGERY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100025AF
Medicare Provider Number
100025
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
12/6/2010
Participating Start Date
1/1/2011
Participating Approval Date
12/22/2010
Last Recertification Date
9/1/2022
Termination Date
Termination Reason
7/1/2023
Site closure
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
5153 N. 9TH AVE.
SUITE 300
PENSACOLA, FL 32504
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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