340B Drug Pricing Program Database
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DSH100281N MEMORIAL HOSPITAL WEST (Active)
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Main Details
Name
MEMORIAL HOSPITAL WEST
Subdivision Name
MCI WEST RADIATION ONC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100281N
Medicare Provider Number
100281
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/12/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/12/2016
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Memorial Hospital West
JOSEPH STUCZYNSKI, CEO
(954) 844-6871
Primary Contact
Memorial Healthcare System
Alexsandra Soto, Director, 340B Program
(954) 276-1771
Addresses
Street Address
12235 Pines Blvd.
Pembroke Pines, FL 33026
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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