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DSH100075BC ST JOSEPH'S HOSPITAL (Active)
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Main Details
Name
ST JOSEPH'S HOSPITAL
Subdivision Name
ST JOSEPH'S HOSPITAL - SOUTH - St. Joseph's Hospital South Non-invasive Cardiology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100075BC
Medicare Provider Number
100075
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/15/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/31/2019
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Baycare Health System
Carl Tremonti, Chief Financial Officer
(813) 870-4020
Primary Contact
BayCare Health System
Kyle J Brauer, Manager, BayCare Pharmacy Supply Chain
(813) 901-6376
Addresses
Street Address
6901 SIMMONS LOOP
RIVERVIEW, FL 33578-9498
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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