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DSH100022AB JACKSON HEALTH SYSTEM (Active)
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Main Details
Name
JACKSON HEALTH SYSTEM
Subdivision Name
Miami Transplant Institute
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100022AB
Medicare Provider Number
100022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/13/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/15/2017
Last Recertification Date
8/29/2024
Contacts
Authorizing Official
Jackson Health System
Carlos A. Migoya, CEO
(305) 585-6754
Primary Contact
Jackson Health System
VENESSA GOODNOW, AVP & CHIEF PHARMACY OFFICER
(305) 585-7411
Addresses
Street Address
1801 NW 9th Avenue
Miami, FL 33136
Billing Address
Jackson Memorial Hospital
1611 NW 12th Ave
Miami, FL 33136
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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