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DSH100025BR SACRED HEART HEALTH SYSTEM (Terminated)
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Main Details
Name
SACRED HEART HEALTH SYSTEM
Subdivision Name
Osteo Imaging
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100025BR
Medicare Provider Number
100025
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2014
Participating Start Date
4/1/2014
Participating Approval Date
2/27/2014
Last Recertification Date
8/19/2015
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Sacred Heart Health System, Inc.
Susan Cornejo, Chief Operating Officer
(850) 416-6206
Primary Contact
Steve Poole, Director Medical Practices
(850) 416-7039
Addresses
Street Address
1549 Airport Blvd.
Suite 350
Pensacola, FL 32504
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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