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SOUTH BROWARD HOSPITAL DISTRICT
DSH100285C MEMORIAL HOSPITAL MIRAMAR
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Covered Entity Details
Entity Name
MEMORIAL HOSPITAL MIRAMAR
Subdivision Name
MOB II Women's Center - MOB II Women's Center
Type
Disproportionate Share Hospital
340B ID
DSH100285C
Entity Address
1971 SW 172nd Avenue
Miramar, FL 33029
Medicare Provider Number
100285
Outpatient Facility Provider Number
Participating Start Date
1/1/2024
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
SOUTH BROWARD HOSPITAL DISTRICT
Pharmacy Address
MEMORIAL WEST OUTPATIENT PHARMACY
601 N FLAMINGO RD STE 110
PEMBROKE PINES, FL 33028-1007
Pharmacy Comments
Contract Details
Approval Date
10/30/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephen L Demers, CEO
(954) 538-4800
Contract Pharmacy Representative
Memorial Healthcare System
Dorinda Segovia, Vice President of Pharmacy Services
(954) 276-1770
Signed By Date
10/16/2023
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