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SOUTH BROWARD HOSPITAL DISTRICT
DSH100281T MEMORIAL HOSPITAL WEST
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Covered Entity Details
Entity Name
MEMORIAL HOSPITAL WEST
Subdivision Name
Memorial Primary Care Silver Lakes Practice
Type
Disproportionate Share Hospital
340B ID
DSH100281T
Entity Address
17786 SW 2nd Street
Pembroke Pines, FL 33029-3923
Medicare Provider Number
100281
Outpatient Facility Provider Number
Participating Start Date
1/1/2019
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
SOUTH BROWARD HOSPITAL DISTRICT
Pharmacy Address
MEMORIAL WEST OUTPATIENT PHARMACY
601 N FLAMINGO RD STE 110
PEMBROKE PINES, FL 33028-1007
Pharmacy Comments
Contract Details
Approval Date
2/26/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
4/1/2020
Contract Comments
Contacts
Covered Entity Signing Official
LEAH CARPENTER, CEO
(954) 844-7500
Contract Pharmacy Representative
Memorial Healthcare System
Dorinda Segovia, Vice President of Pharmacy Services
(954) 276-1770
Signed By Date
2/26/2020
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