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DSH100075AD ST JOSEPH'S HOSPITAL (Active)
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Main Details
Name
ST JOSEPH'S HOSPITAL
Subdivision Name
St. Josephs Hospital South Nuclear Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100075AD
Medicare Provider Number
100075
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/13/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/22/2016
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Baycare Health System
Carl Tremonti, Chief Financial Officer
(813) 870-4020
Primary Contact
BayCare Health System
Kyle J Brauer, Manager, BayCare Pharmacy Supply Chain
(813) 901-6376
Addresses
Street Address
6901 SIMMONS LOOP
RIVERVIEW, FL 33578-9498
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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