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SOUTH BROWARD HOSPITAL DISTRICT
DSH100038N MEMORIAL REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
MEMORIAL REGIONAL HOSPITAL
Subdivision Name
Outpatient Therapy - Coral Springs
Type
Disproportionate Share Hospital
340B ID
DSH100038N
Entity Address
5830 Coral Ridge Drive
Suite 207
Coral Springs, FL 33076
Medicare Provider Number
100038
Outpatient Facility Provider Number
Participating Start Date
7/1/2014
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
SOUTH BROWARD HOSPITAL DISTRICT
Pharmacy Address
MEMORIAL REGIONAL HOSPITAL PRIMARY CARE
4105 PEMBROKE RD.
HOLLYWOOD, FL 33021
Pharmacy Comments
Contract Details
Approval Date
12/4/2020
Contract Begin Date
12/4/2020
Carve-In Effective Date
12/4/2020
Contract Comments
Contacts
Covered Entity Signing Official
Peter Powers, CEO, Memorial Regional Hospital
(954) 265-5814
Contract Pharmacy Representative
Memorial Healthcare System
Dorinda Segovia, Vice President of Pharmacy Services
(954) 276-1770
Signed By Date
12/4/2020
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