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SOUTH BROWARD HOSPITAL DISTRICT
DSH100285 MEMORIAL HOSPITAL MIRAMAR
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Covered Entity Details
Entity Name
MEMORIAL HOSPITAL MIRAMAR
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100285
Entity Address
1901 SW 172ND AVENUE
Miramar, FL 33029
Medicare Provider Number
100285
Participating Start Date
10/1/2006
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
10/13/2015
Contract Begin Date
1/1/2016
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
Gordon Garland, Director of Ambulatory Services
(954) 276-9801
Signed By Date
10/13/2015
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