340B Drug Pricing Program Database
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DSH100281S MEMORIAL HOSPITAL WEST (Active)
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Main Details
Name
MEMORIAL HOSPITAL WEST
Subdivision Name
Moffitt Physicians - Oncology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100281S
Medicare Provider Number
100281
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/15/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/23/2018
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Memorial Hospital West
JOSEPH STUCZYNSKI, CEO
(954) 844-6871
Primary Contact
Memorial Healthcare System
Alexsandra Soto, Director, 340B Program
(954) 276-1771
Addresses
Street Address
12235 Pines Blvd.
Pembroke Pines, FL 33026
Billing Address
Memorial Healthcare System
PO BOX 269001
Attn: Accounts Payable
Pembroke Pines, FL 33026
Comments
Medicaid Billing
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Contract Pharmacies
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