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DSH100135H TALLAHASSEE MEMORIAL HEALTHCARE, INC (Active)
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Main Details
Name
TALLAHASSEE MEMORIAL HEALTHCARE, INC
Subdivision Name
Tallahassee Memorial Physician Partners Monticello
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100135H
Medicare Provider Number
100135
Outpatient Facility Provider Number
103409
Additional Details
Current Program Status
Active
Registration Date
1/15/2014
Participating Start Date
4/1/2014
Participating Approval Date
2/18/2014
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Tallahassee Memorial HealthCare
Priscilla Needham, Chief Financial Officer
(850) 431-0630
Primary Contact
Tallahassee Memorial HealthCare
Louis Kynard, Director of Pharmacy
(850) 431-5030
Addresses
Street Address
1549 S. Jefferson Street
Monticello, FL 32344
Billing Address
Tallahassee Memorial HealthCare, Inc
1300 Miccosukee Road
Tallahassee, FL 32308
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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