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RRC100157-00 LAKELAND REGIONAL MED CTR (Terminated)
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Main Details
Name
LAKELAND REGIONAL MED CTR
Subdivision Name
Type
Rural Referral Center
Rural
No
340B ID
RRC100157-00
Medicare Provider Number
100157
Additional Details
Current Program Status
Terminated
Registration Date
2/28/2018
Participating Start Date
2/28/2018
Participating Approval Date
2/28/2018
Last Recertification Date
8/28/2019
Termination Date
Termination Reason
1/1/2020
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
Lakeland Regional Medical Center, Inc.
Lance Green, EVP/Chief Financial Officer
(863) 687-1100 Ext: 5225
Primary Contact
Lakeland Regional Medical Center, Inc.
Jason Alan McNeil, AVP/Finance
(863) 687-1100 Ext: 1011
Addresses
Street Address
1324 LAKELAND HILLS BLVD
LAKELAND, FL 33805
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from (1/1/2017) until terminated effective date: (7/1/2017), reinstatement date (02/28/18)
02/28/2018
April 2025
April 2025
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