340B Drug Pricing Program Database
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DSH100281R MEMORIAL HOSPITAL WEST (Active)
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Main Details
Name
MEMORIAL HOSPITAL WEST
Subdivision Name
Memorial Primary Care / West Miramar
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100281R
Medicare Provider Number
100281
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/17/2016
Participating Start Date
1/1/2017
Participating Approval Date
11/1/2016
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
10910 Pembroke Road
Miramar, FL 33025
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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April 2025
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