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DSH100038BH MEMORIAL REGIONAL HOSPITAL (Terminated)
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Main Details
Name
MEMORIAL REGIONAL HOSPITAL
Subdivision Name
JDCH - Outpatient Surgery: Recovery Room
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100038BH
Medicare Provider Number
100038
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/5/2015
Last Recertification Date
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
3501 Johnson Street
JDCH
Hollywood, FL 33021
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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