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DSH100022BP JACKSON HEALTH SYSTEM (Active)
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Main Details
Name
JACKSON HEALTH SYSTEM
Subdivision Name
JACKSON NORTH MEDICAL CENTER - Respiratory Therapy
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100022BP
Medicare Provider Number
100022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/10/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/18/2018
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
160 NW 170TH STREET
NORTH MIAMI BEACH, FL 33169-5521
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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