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DANIA REXALL PHARMACY & MEDICAL SUPPLY,
DSH100038C MEMORIAL REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
MEMORIAL REGIONAL HOSPITAL
Subdivision Name
Memorial Primary Care Clinic- Dania Beach
Type
Disproportionate Share Hospital
340B ID
DSH100038C
Entity Address
140A South Federal Highway
Dania Beach, FL 33004
Medicare Provider Number
100038
Outpatient Facility Provider Number
Participating Start Date
7/1/2004
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
DANIA REXALL PHARMACY & MEDICAL SUPPLY,
Pharmacy Address
DANIA DISCOUNT DRUGS,INC.
5420 NW 33RD AVE STE 7A
FORT LAUDERDALE, FL 33309
Pharmacy Comments
Contract Details
Approval Date
7/1/2004
Contract Begin Date
7/1/2004
Carve-In Effective Date
Contract Comments
5/16/05 ADMIN CORRECTION (PREVIOUSLY LINKED TO 340 ID# DSH33021C)
Contract Termination Date
Termination Reason
7/27/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
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