Covered Entity Details

DSH100038 MEMORIAL REGIONAL HOSPITAL (Active)

Main Details

Name

MEMORIAL REGIONAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH100038

Medicare Provider Number

100038

Additional Details

Current Program Status

Active

Registration Date

10/1/2002

Participating Start Date

10/1/2002

Participating Approval Date

5/16/2005

Last Recertification Date

8/13/2024

Contacts

Authorizing Official

Memorial Regional Hospital
AURELIO FERNANDEZ, CEO
(954) 265-5014

Primary Contact

Memorial Healthcare System
Alexsandra Soto, Director, 340B Program
(954) 276-1771

Addresses

Street Address

3501 Johnson Street
Hollywood, FL 33021

Billing Address

Memorial Healthcare System
PO Box 269001
Attn: Accounts Payable
Pembroke Pines, FL 33026

Comment	Last Updated On
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8/26/13 DSH% updated to reflect Allowable DSH percent and verified via cost report JH 4/7/2010- AMDP- NETWORK- SOUTH BROWARD HOSPITAL DISTRICT; 12/18/09 AMDP APPROVED ON 10/15/09 ADDED SHIP TO; 5/16/05 ADMIN CORRECTION REPLACES DSH33021	08/26/2013
4/7/2010- AMDP- NETWORK- SOUTH BROWARD HOSPITAL DISTRICT; 12/18/09 AMDP APPROVED ON 10/15/09 ADDED SHIP TO; 5/16/05 ADMIN CORRECTION REPLACES DSH33021	05/15/2012
4/7/2010- AMDP- NETWORK- SOUTH BROWARD HOSPITAL DISTRICT; 12/18/09 AMDP APPROVED ON 10/15/09 ADDED SHIP TO; 5/16/05 ADMIN CORRECTION REPLACES DSH33021	01/21/2010
4/7/2010- AMDP- NETWORK- SOUTH BROWARD HOSPITAL DISTRICT; 12/18/09 AMDP APPROVED ON 10/15/09 ADDED SHIP TO; 5/16/05 ADMIN CORRECTION REPLACES DSH33021	10/01/2002

340B Drug Pricing Program Database