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DSH100038H SOUTH BROWARD HOSPITAL DISTRICT DBA MEMORIAL REGIONAL HOSPITAL (Terminated)
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Main Details
Name
SOUTH BROWARD HOSPITAL DISTRICT DBA MEMORIAL REGIONAL HOSPITAL
Subdivision Name
South Broward Hospital District DBA Joe DiMaggio Children's Hospital
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100038H
Medicare Provider Number
100038
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/30/2011
Participating Start Date
10/1/2011
Participating Approval Date
9/19/2011
Last Recertification Date
8/11/2015
Termination Date
Termination Reason
4/1/2016
Site closure
Contacts
Authorizing Official
Memorial Healthcare System
Peter Powers, CEO, Memorial Regional Hospital
(954) 265-5814
Primary Contact
Keith Fricker, Director, Pharmacy Contracting
(954) 276-5491
Addresses
Street Address
1005 Joe DiMaggio Dr.
Hollywood, FL 33021
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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