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DSH100025AW SACRED HEART HEALTH SYSTEM (Active)
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Main Details
Name
SACRED HEART HEALTH SYSTEM
Subdivision Name
Sacred Heart Medical Group - Neurology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100025AW
Medicare Provider Number
100025
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
2/22/2024
Participating Start Date
4/1/2024
Participating Approval Date
2/28/2024
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 Ave.
Suite 404
Pensacola, FL 32504
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting- 4/1/2014 Terminated starting- 1/1/2016 Reinstated- 4/1/2024
02/28/2024
May 2025
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