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BAYCARE HOME CARE INC
DSH100052A WINTER HAVEN HOSPITAL
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Covered Entity Details
Entity Name
WINTER HAVEN HOSPITAL
Subdivision Name
Winter Haven Women's Hospital
Type
Disproportionate Share Hospital
340B ID
DSH100052A
Entity Address
101 AVENUE O, SE
WINTER HAVEN, FL 33880
Medicare Provider Number
100052
Outpatient Facility Provider Number
Participating Start Date
1/1/2008
Last Recertification Date
8/31/2015
Entity Termination Date
4/1/2016
Pharmacy Details
Pharmacy Name
BAYCARE HOME CARE INC
Pharmacy Address
8452 118TH AVE N
LARGO, FL 33773-5007
Pharmacy Comments
Contract Details
Approval Date
4/13/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Carl Tremonti, Chief Financial Officer
(813) 870-4020
Contract Pharmacy Representative
Iqbal Burney, Director of Pharmacy
(727) 394-6577
Signed By Date
4/13/2015
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