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DSH100006AK ORLANDO HEALTH (Terminated)
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Main Details
Name
ORLANDO HEALTH
Subdivision Name
ACC ENDOSCOPY / Endoscopy
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100006AK
Medicare Provider Number
100006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2015
Participating Start Date
1/1/2016
Participating Approval Date
10/28/2015
Last Recertification Date
11/21/2017
Termination Date
Termination Reason
4/1/2018
Site closure
Contacts
Authorizing Official
orlando health
BERNADETTE SPONG, CFO
(321) 841-5078
Primary Contact
Orlando Health
James Moye II, 340B Program Coordinator
(321) 841-6656
Addresses
Street Address
22 W Underwood Street
2nd Floor
Orlando, FL 32806
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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