340B Drug Pricing Program Database
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DSH100088BD BAPTIST MEDICAL CENTER (Terminated)
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Main Details
Name
BAPTIST MEDICAL CENTER
Subdivision Name
Thoracic Surgery - BMDA
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100088BD
Medicare Provider Number
100088
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2022
Participating Start Date
1/1/2023
Participating Approval Date
10/17/2022
Last Recertification Date
8/24/2023
Termination Date
Termination Reason
7/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Baptist Medical Center
Scott Finnegan, Senior Vice President of Finance/Treasury
(904) 202-3270
Primary Contact
Baptist Medical Center
Pamela Michelle Johnston, Sr 340B Pharmacy Specialist
(904) 202-5255
Addresses
Street Address
1301 Palm Ave
6th Floor
Jacksonville, FL 32207
Billing Address
Baptist Medical Center
PO Box 45128
Jacksonville, FL 32232
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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