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SOUTH BROWARD HOSPITAL DISTRICT
DSH100230 MEMORIAL HOSPITAL PEMBROKE
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Covered Entity Details
Entity Name
MEMORIAL HOSPITAL PEMBROKE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100230
Entity Address
7800 SHERIDAN STREET
PEMBROKE PINES, FL 33024
Medicare Provider Number
100230
Participating Start Date
1/1/2003
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
2/23/2009
Contract Begin Date
2/23/2009
Carve-In Effective Date
4/1/2020
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
2/11/2009
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