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DSH210019 TIDALHEALTH PENINSULA REGIONAL INC (Active)
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Main Details
Name
TIDALHEALTH PENINSULA REGIONAL INC
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH210019
Medicare Provider Number
210019
Additional Details
Current Program Status
Active
Registration Date
4/4/2017
Participating Start Date
3/15/2022
Participating Approval Date
6/8/2017
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
TidalHealth
John Jordan, Senior Director of Pharmacy
(410) 543-7054
Primary Contact
TidalHealth Peninsula Regional
Daehak Yim, 340B coordinator
(410) 543-7585
Addresses
Street Address
100 EAST CARROLL STREET
SALISBURY, MD 21801
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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November 2024
November 2024
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