340B Drug Pricing Program Database
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DSH100135L TALLAHASSEE MEMORIAL HEALTHCARE, INC (Terminated)
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Main Details
Name
TALLAHASSEE MEMORIAL HEALTHCARE, INC
Subdivision Name
Tallahassee Memorial Wound Healing Center - Wound Healing Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100135L
Medicare Provider Number
100135
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/13/2020
Participating Start Date
1/1/2021
Participating Approval Date
10/19/2020
Last Recertification Date
9/16/2022
Termination Date
Termination Reason
7/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
Tallahassee Memorial HealthCare
Priscilla Needham, Chief Financial Officer
(850) 431-0630
Primary Contact
Tallahassee Memorial HealthCare
Louis Kynard, Director of Pharmacy
(850) 431-5030
Addresses
Street Address
1505 Surgeons Drive
Tallahassee, FL 32308
Billing Address
Tallahassee Memorial Healthcare, Inc
1300 Miccosukee Road
Tallaahassee, FL 32308
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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