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SOUTH BROWARD HOSPITAL DISTRICT
DSH100038 MEMORIAL REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
MEMORIAL REGIONAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100038
Entity Address
3501 Johnson Street
Hollywood, FL 33021
Medicare Provider Number
100038
Participating Start Date
10/1/2002
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
SOUTH BROWARD HOSPITAL DISTRICT
Pharmacy Address
MEMORIAL WEST OUTPATIENT PHARMACY
601 N FLAMINGO RD STE 110
PEMBROKE PINES, FL 33028-1007
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
4/1/2020
Contract Comments
Contacts
Covered Entity Signing Official
ZEFF ROSS, CEO
(954) 265-5814
Contract Pharmacy Representative
Memorial Healthcare System
Gordon Garland, Director of Ambulatory Services
(954) 276-9801
Signed By Date
1/15/2018
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