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DSH100038AZ 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 Pediatric Ambulatory Services (Clinic)
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100038AZ
Medicare Provider Number
100038
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/22/2015
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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April 2025
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