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BAYCARE HOME CARE, INC.
DSH100075 ST JOSEPH'S HOSPITAL
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Covered Entity Details
Entity Name
ST JOSEPH'S HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100075
Entity Address
3001 WEST DR. M L KING JR BLVD
TAMPA, FL 33607
Medicare Provider Number
100075
Participating Start Date
4/1/2003
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
BAYCARE HOME CARE, INC.
Pharmacy Address
D/B/A BAYCARE PHARMACY
3003 W DR MARTIN LUTHER KING JR. BLVD
TAMPA, FL 33607
Pharmacy Comments
Contract Details
Approval Date
10/10/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/14/2017
Ownership change
Contacts
Covered Entity Signing Official
Lorraine Lutton, President, St. Joseph's Hospital
(813) 870-4020
Contract Pharmacy Representative
Iqbal Burney, Director of Pharmacy
(727) 394-6577
Signed By Date
10/10/2013
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