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DSH100022AC JACKSON HEALTH SYSTEM (Terminated)
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Main Details
Name
JACKSON HEALTH SYSTEM
Subdivision Name
JACKSON URGENT CARE-COUNTRY WALK
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100022AC
Medicare Provider Number
100022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2017
Participating Start Date
7/1/2017
Participating Approval Date
5/11/2017
Last Recertification Date
8/27/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
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
13707 SW 152 STREET
UHEALTH@JACKSON URGENT CARE-COUNTRY WALK
MIAMI, FL 33177-1106
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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