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DSH100038Z SOUTH BROWARD HOSPITAL DISTRICT DBA MEMORIAL REGIONAL HOSPITAL (Terminated)
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Main Details
Name
SOUTH BROWARD HOSPITAL DISTRICT DBA MEMORIAL REGIONAL HOSPITAL
Subdivision Name
JDCH - Anestheiology Operating (Outpatient Surgery)
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100038Z
Medicare Provider Number
100038
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2014
Participating Start Date
7/1/2014
Participating Approval Date
4/22/2014
Last Recertification Date
8/11/2015
Termination Date
Termination Reason
4/1/2016
Site closure
Contacts
Authorizing Official
Memorial Healthcare System
Peter Powers, CEO, Memorial Regional Hospital
(954) 265-5814
Primary Contact
Keith Fricker, Director, Pharmacy Contracting
(954) 276-5491
Addresses
Street Address
1005 Joe DiMaggio Drive
Hollywood, FL 33021
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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