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RRC100105-34 INDIAN RIVER MEMORIAL HOSPITA.L (Terminated)
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Main Details
Name
INDIAN RIVER MEMORIAL HOSPITA.L
Subdivision Name
VERO BEACH 35th LN - Rheumatology - HEALTH & WELLNESS RHEUMATOLOGY
Type
Rural Referral Center
Rural
No
340B ID
RRC100105-34
Medicare Provider Number
100105
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/16/2023
Participating Start Date
10/1/2023
Participating Approval Date
9/8/2023
Last Recertification Date
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
1155 35TH LN
VERO BEACH, FL 32960
Billing Address
Cleveland Clinic
6801 Brecksville Road
Mail Code: RK1-25
Suite 20
Independence, OH 44131
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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