340B Drug Pricing Program Database
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DSH100022Y JACKSON HEALTH SYSTEM (Terminated)
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Main Details
Name
JACKSON HEALTH SYSTEM
Subdivision Name
JNMC NURSING SERVICES
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100022Y
Medicare Provider Number
100022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/6/2015
Last Recertification Date
9/2/2021
Termination Date
Termination Reason
10/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Jackson Health System
Carlos A. Migoya, CEO
(305) 585-6754
Primary Contact
Jackson Health System
VENESSA GOODNOW, AVP & CHIEF PHARMACY OFFICER
(305) 585-7411
Addresses
Street Address
160 NW 170 STREET
NORTH MIAMI BEACH, FL 33169
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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