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DSH100093AW BAPTIST HOSPITAL (Terminated)
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Main Details
Name
BAPTIST HOSPITAL
Subdivision Name
BH Family Medicine GB 100 - BH Family Medicine GB 100
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100093AW
Medicare Provider Number
100093
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/10/2020
Participating Start Date
4/1/2020
Participating Approval Date
1/31/2020
Last Recertification Date
9/11/2020
Termination Date
Termination Reason
10/1/2021
Site closure
Contacts
Authorizing Official
Baptist Health Care
Andrew L. Terry, Vice President Revenue Management
(850) 469-7643
Primary Contact
BHC
Frederick Seelmann, Executive Director of Pharmacy
(850) 469-7567
Addresses
Street Address
1118 Gulf Breeze Parkway
Suite 100-B
Gulf Breeze, FL 32561
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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