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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
8452 118TH AVE N
LARGO, FL 33773-5007
Pharmacy Comments
Contract Details
Approval Date
4/7/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
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
4/7/2015
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