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DSH100200 BROWARD HEALTH IMPERIAL POINT (Active)
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Main Details
Name
BROWARD HEALTH IMPERIAL POINT
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100200
Medicare Provider Number
100200
Additional Details
Current Program Status
Active
Registration Date
10/13/2023
Participating Start Date
1/1/2024
Participating Approval Date
10/27/2023
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Broward Health Imperial Point
Alfredo C Guevara, Chief Financial Officer
(954) 776-8711
Primary Contact
North Broward Hospital District dba Broward Health
Dave A Lacknauth, Executive Director of Pharmacy Services
(954) 473-7078
Addresses
Street Address
6401 N FEDERAL HIGHWAY
FT. LAUDERDALE, FL 33308
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (01/1/2023) until terminated effective date: (01/1/2023), reinstatement effective date: (01/1/2024)
10/27/2023
June 2025
June 2025
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