340B Drug Pricing Program Database
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DSH100038BB MEMORIAL REGIONAL HOSPITAL (Active)
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Main Details
Name
MEMORIAL REGIONAL HOSPITAL
Subdivision Name
Memorial Primary Care Adult Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100038BB
Medicare Provider Number
100038
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/15/2015
Participating Start Date
1/1/2016
Participating Approval Date
12/2/2015
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Memorial Regional Hospital
AURELIO FERNANDEZ, CEO
(954) 265-5014
Primary Contact
Memorial Healthcare System
Alexsandra Soto, Director, 340B Program
(954) 276-1771
Addresses
Street Address
4105 Pembroke Road
Hollywood, FL 33021
Billing Address
Memorial Healthcare System
PO Box 269001
Attn: Accounts Payable
Pembroke Pines, FL 33026
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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