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DSH100038AW MEMORIAL REGIONAL HOSPITAL (Active)
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Main Details
Name
MEMORIAL REGIONAL HOSPITAL
Subdivision Name
Memorial Primary Care Gulfstream
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100038AW
Medicare Provider Number
100038
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
8/13/2024
Contacts
Authorizing Official
Memorial Regional Hospital
AURELIO FERNANDEZ, CEO
(954) 265-5014
Primary Contact
Memorial Healthcare System
Alexsandra Soto, Director, 340B Program
(954) 276-1771
Addresses
Street Address
2056 Scott Street
Hollywood, FL 33020
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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