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DSH100038K MEMORIAL REGIONAL HOSPITAL (Terminated)
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Main Details
Name
MEMORIAL REGIONAL HOSPITAL
Subdivision Name
Memorial Home Health Services
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100038K
Medicare Provider Number
100038
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/10/2014
Participating Start Date
4/1/2014
Participating Approval Date
3/10/2014
Last Recertification Date
8/12/2016
Termination Date
Termination Reason
10/1/2017
Site closure
Contacts
Authorizing Official
Memorial Healthcare System
Peter Powers, CEO, Memorial Regional Hospital
(954) 265-5814
Primary Contact
Memorial Healthcare System
Halena Leah Marcelin, 340B Program Manager
(954) 265-3212
Addresses
Street Address
7369 Sheridan Street, Suite 101
Hollywood, FL 33021
Billing Address
South Broward Hospital District DBA Memorial Regional Hospital
3501 Johnson St
Hollywood, FL 33021
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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