340B Drug Pricing Program Database
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DSH100038BA MEMORIAL REGIONAL HOSPITAL (Terminated)
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Main Details
Name
MEMORIAL REGIONAL HOSPITAL
Subdivision Name
Memorial Primary Care Pediatric Mobile Van
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100038BA
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
10/29/2015
Last Recertification Date
8/25/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Memorial Healthcare System
Peter Powers, CEO, Memorial Regional Hospital
(954) 265-5814
Primary Contact
Memorial Healthcare System
Alexsandra Soto, Director, 340B Program
(954) 276-1771
Addresses
Street Address
3600 Washington Street
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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