340B Drug Pricing Program Database
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DSH100025AQ SACRED HEART HEALTH SYSTEM (Terminated)
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Main Details
Name
SACRED HEART HEALTH SYSTEM
Subdivision Name
SACRED HEART MEDICAL ONCOLOGY GROUP
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100025AQ
Medicare Provider Number
100025
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
6/17/2011
Participating Start Date
7/1/2011
Participating Approval Date
6/17/2011
Last Recertification Date
8/19/2024
Termination Date
Termination Reason
4/1/2025
Business decision by the Covered Entity
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
1545 AIRPORT BLVD
SUITE 3200
PENSACOLA, FL 32504
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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