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SOUTH BROWARD HOSPITAL DISTRICT
DSH100038 MEMORIAL REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
MEMORIAL REGIONAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100038
Entity Address
3501 Johnson Street
Hollywood, FL 33021
Medicare Provider Number
100038
Participating Start Date
10/1/2002
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
SOUTH BROWARD HOSPITAL DISTRICT
Pharmacy Address
MEMORIAL HOME INFUSION
9579 PREMIER PKWY
MIRAMAR, FL 33025-3206
Pharmacy Comments
Contract Details
Approval Date
7/19/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
4/1/2020
Contract Comments
Contacts
Covered Entity Signing Official
ZEFF ROSS, CEO
(954) 265-5814
Contract Pharmacy Representative
Memorial Home Infusion
Patricia Taylor, Director of Pharmacy
(954) 518-5676
Signed By Date
7/19/2018
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