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DSH100075AV ST JOSEPH'S HOSPITAL (Active)
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Main Details
Name
ST JOSEPH'S HOSPITAL
Subdivision Name
Nuclear Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100075AV
Medicare Provider Number
100075
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/14/2016
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
4211 VAN DYKE RD
LUTZ, FL 33558-8005
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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