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DSH100025EG SACRED HEART HEALTH SYSTEM (Active)
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Main Details
Name
SACRED HEART HEALTH SYSTEM
Subdivision Name
SHMG Rheum at Destin Market Shops (DMKT) - Rheumatology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100025EG
Medicare Provider Number
100025
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/7/2024
Participating Start Date
4/1/2024
Participating Approval Date
2/8/2024
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Sacred Heart Health System, Inc.
Susan Cornejo, Chief Operating Officer
(850) 416-6206
Primary Contact
Sacred Heart Health System, Inc.
Troy Russo, 340B Coordinator
(850) 416-2859
Addresses
Street Address
9375 Emerald Coast Pkwy
Unit 1
Unit 1
Miramar Beach, FL 32550-7274
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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