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BAYCARE HOME CARE INC
DSH100063 MORTON PLANT NORTH BAY HOSPITAL
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Covered Entity Details
Entity Name
MORTON PLANT NORTH BAY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100063
Entity Address
6600 MADISON STREET
NEW PORT RICHEY, FL 34652-1971
Medicare Provider Number
100063
Participating Start Date
1/1/2015
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
BAYCARE HOME CARE INC
Pharmacy Address
D/B/A/ BAY CARE PHARMACY
1840 MEASE DR
SUITE 100
SAFETY HARBOR, FL 34695
Pharmacy Comments
Contract Details
Approval Date
4/7/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/21/2017
Ownership change
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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