340B Drug Pricing Program Database
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DSH100006HY ORLANDO HEALTH (Terminated)
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Main Details
Name
ORLANDO HEALTH
Subdivision Name
LAKE MARY FSED - 9173 LM IMAGING
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100006HY
Medicare Provider Number
100006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2020
Participating Start Date
7/1/2020
Participating Approval Date
5/4/2020
Last Recertification Date
8/21/2023
Termination Date
Termination Reason
4/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Orlando Health
Leslie Flake Flake, CFO
(321) 841-5078
Primary Contact
Orlando Health
Lacey Jory, 340B Program Supervisor
(321) 843-9045
Addresses
Street Address
380 RINEHART RD
LAKE MARY, FL 32746
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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