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CORAM HEALTHCARE CORPORATION OF FLORIDA
DSH100093 BAPTIST HOSPITAL
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Covered Entity Details
Entity Name
BAPTIST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100093
Entity Address
123 Baptist Way
PENSACOLA, FL 32503
Medicare Provider Number
100093
Participating Start Date
4/1/2009
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
CORAM HEALTHCARE CORPORATION OF FLORIDA
Pharmacy Address
DBA CORAM CVS/SPECIALTY INFUSION SERVICE
8508 BENJAMIN RD
SUITE C
TAMPA, FL 33634-1241
Pharmacy Comments
Contract Details
Approval Date
7/26/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/17/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Andrew L. Terry, Vice President Revenue Management
(850) 469-7643
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/26/2021
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