340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH100017J HALIFAX HEALTH MEDICAL CENTER (Terminated)
Print
Main Details
Name
HALIFAX HEALTH MEDICAL CENTER
Subdivision Name
Halifax Health - 201 Building
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100017J
Medicare Provider Number
100017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/4/2013
Participating Start Date
7/1/2013
Participating Approval Date
5/17/2013
Last Recertification Date
8/31/2016
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
Halifax Hospital Medical Center
ERIC M. PEBURN, CFO
(386) 425-4568
Primary Contact
Halifax Health
Kern Dowsett, Reimbursement Specialist
(386) 425-4567
Addresses
Street Address
201 N. Clyde Morris
Daytona Beach, FL 32114
Billing Address
Halifax Health Medical Center
303 N. Clyde Morris Blvd.
Daytona Beach, FL 32114
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
May 2025
May 2025
week
S
M
T
W
T
F
S
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
20
11
12
13
14
15
16
17
21
18
19
20
21
22
23
24
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session