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RRC100105-00 INDIAN RIVER MEMORIAL HOSPITA.L (Terminated)
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Main Details
Name
INDIAN RIVER MEMORIAL HOSPITA.L
Subdivision Name
Type
Rural Referral Center
Rural
No
340B ID
RRC100105-00
Medicare Provider Number
100105
Additional Details
Current Program Status
Terminated
Registration Date
1/4/2022
Participating Start Date
4/1/2022
Participating Approval Date
2/2/2022
Last Recertification Date
8/30/2023
Termination Date
Termination Reason
7/1/2024
DSH percentage below statutory minimum
Contacts
Authorizing Official
Indian River Memorial Hospital
Charmaine Rochester, Chief Financial Officer
(786) 848-2854
Primary Contact
Cleveland Clinic
Jonathan Williams, Senior Director of Pharmacy - 340B
(216) 444-8884
Addresses
Street Address
1000 36TH STREET
VERO BEACH, FL 32960
Billing Address
Indian River Memorial Hosp
1000 36TH STREET
VERO BEACH, FL 32960
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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