340B Drug Pricing Program Database
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DSH100038AV MEMORIAL REGIONAL HOSPITAL (Active)
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Main Details
Name
MEMORIAL REGIONAL HOSPITAL
Subdivision Name
Memorial Regional Hospital South / Outpatient Surgery: Anesthesiology-Operating
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100038AV
Medicare Provider Number
100038
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/14/2014
Participating Start Date
7/1/2014
Participating Approval Date
4/23/2014
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Memorial Regional Hospital
AURELIO FERNANDEZ, CEO
(954) 265-5014
Primary Contact
Memorial Healthcare System
Alexsandra Soto, Director, 340B Program
(954) 276-1771
Addresses
Street Address
3600 Washington Street
Hollywood, FL 33021
Billing Address
Memorial Healthcare System
PO Box 269001
Attn: Accounts Payable
Pembroke Pines, FL 33026
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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