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DSH100025BB SACRED HEART HEALTH SYSTEM (Active)
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Main Details
Name
SACRED HEART HEALTH SYSTEM
Subdivision Name
Dr. Jimenez Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100025BB
Medicare Provider Number
100025
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/14/2014
Participating Start Date
4/1/2014
Participating Approval Date
2/27/2014
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
7720 Hwy. 98 W.
Suite 350
Miramar Beach, FL 32550
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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