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SOUTH BROWARD HOSPITAL DISTRICT
DSH100281U MEMORIAL HOSPITAL WEST
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Covered Entity Details
Entity Name
MEMORIAL HOSPITAL WEST
Subdivision Name
Memorial Primary Care - Monarch Lakes
Type
Disproportionate Share Hospital
340B ID
DSH100281U
Entity Address
12781 Miramar Parkway
Suite 1-202
Miramar, FL 33027
Medicare Provider Number
100281
Outpatient Facility Provider Number
Participating Start Date
1/1/2020
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
SOUTH BROWARD HOSPITAL DISTRICT
Pharmacy Address
MEMORIAL SPECIALTY PHARMACY
9571 PREMIER PKWY
MIRAMAR, FL 33025-3206
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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