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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 SPECIALTY PHARMACY
9571 PREMIER PKWY
MIRAMAR, FL 33025-3206
Pharmacy Comments
Contract Details
Approval Date
7/28/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
4/1/2020
Contract Comments
Contacts
Covered Entity Signing Official
Mark Doyle, CEO
(954) 883-8401
Contract Pharmacy Representative
MHM
Madeline Camejo, VP of Specialty and Ambulatory Care Pharmacy Services
(954) 265-4326
Signed By Date
7/28/2017
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