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DSH100154Q SOUTH MIAMI HOSPITAL (Terminated)
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Main Details
Name
SOUTH MIAMI HOSPITAL
Subdivision Name
Burn Center - Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100154Q
Medicare Provider Number
100154
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/28/2019
Last Recertification Date
9/14/2022
Termination Date
Termination Reason
10/1/2023
Other
Contacts
Authorizing Official
Baptist Health South Florida
Madeline Camejo, Vice President and Chief Pharmacy Officer
(786) 662-0801
Primary Contact
Baptist Health South Florida
Halena Leah Marcelin, Director, Pharmacy Business Affairs
(786) 662-0805
Addresses
Street Address
6250 Sunset Drive
South Miami, FL 33143
Billing Address
South Miami Hospital
Baptist Health South Florida - Accounts Payable
8900 North Kendall Drive
Miami, FL 33176-2197
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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