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DSH100052E WINTER HAVEN HOSPITAL (Terminated)
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Main Details
Name
WINTER HAVEN HOSPITAL
Subdivision Name
Winter Haven Women's Hospital Surgery
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100052E
Medicare Provider Number
100052
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/6/2015
Last Recertification Date
9/8/2020
Termination Date
Termination Reason
10/1/2021
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Baycare Health System
Carl Tremonti, Chief Financial Officer
(813) 870-4020
Primary Contact
BayCare Health System
Kyle J Brauer, Manager, BayCare Pharmacy Supply Chain
(813) 901-6376
Addresses
Street Address
101 AVENUE O, SE
Winter Haven, FL 33880
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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