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COMMCARE PHARMACY-MIA, LLC
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
COMMCARE PHARMACY-MIA, LLC
Pharmacy Address
1801 CORAL WAY
SUITE 115
MIAMI, FL 33145-2784
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/27/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ZEFF ROSS, CEO
(954) 265-5814
Contract Pharmacy Representative
Vic Simianu, Manager, Special Projects
(954) 332-6150
Signed By Date
4/15/2014
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