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SOUTH BROWARD HOSPITAL DISTRICT
DSH100285D MEMORIAL HOSPITAL MIRAMAR
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Covered Entity Details
Entity Name
MEMORIAL HOSPITAL MIRAMAR
Subdivision Name
MSC Surgical Services - MHM MOB II OP SURGICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH100285D
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 SPECIALTY PHARMACY
9571 PREMIER PKWY
MIRAMAR, FL 33025-3206
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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