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BAPTIST HEALTH PHARMACY #102, LLC
DSH100154 South Miami Hospital
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Covered Entity Details
Entity Name
South Miami Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100154
Entity Address
6200 SW 73rd Street
South Miami, FL 33143
Medicare Provider Number
100154
Participating Start Date
9/9/2005
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
BAPTIST HEALTH PHARMACY #102, LLC
Pharmacy Address
6200 SUNSET DR STE 102
SOUTH MIAMI, FL 33143-4832
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/28/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Madeline Camejo, Vice President and Chief Pharmacy Officer
(786) 662-0801
Contract Pharmacy Representative
Baptist Health Medical Group, Inc
Gordon Garland, Director, Retail Pharmacy
(786) 662-0828
Signed By Date
4/14/2021
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