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DSH100025AS SACRED HEART HEALTH SYSTEM (Active)
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Main Details
Name
SACRED HEART HEALTH SYSTEM
Subdivision Name
Sacred Heart Pediatric Infusion
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100025AS
Medicare Provider Number
100025
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
2/28/2012
Participating Start Date
4/1/2012
Participating Approval Date
3/29/2012
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
5153 N. 9th Avenue
Suite 506
Pensacola, FL 32504
Billing Address
Sacred Heart Health System
5151 N. 9th Avenue
Pensacola, FL 32504
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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