340B Drug Pricing Program Database
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DSH100022BY JACKSON HEALTH SYSTEM (Terminated)
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Main Details
Name
JACKSON HEALTH SYSTEM
Subdivision Name
JACKSON HEALTH SYSTEM - JNMHC PHYSICAL THERAPY#1
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100022BY
Medicare Provider Number
100022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/17/2023
Participating Start Date
4/1/2023
Participating Approval Date
1/26/2023
Last Recertification Date
9/6/2023
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Jackson Health System
Carlos A. Migoya, CEO
(305) 585-6754
Primary Contact
Jackson Health System
VENESSA GOODNOW, AVP & CHIEF PHARMACY OFFICER
(305) 585-7411
Addresses
Street Address
160 NW 170TH ST
NORTH MIAMI BEACH, FL 33169-5521
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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