Covered Entity Details

DSH110031A WellStar Spalding Regional Hospital (Active) - information as of 5/20/2025 11:42:59 PM

Main Details

Name

WellStar Spalding Regional Hospital

Subdivision Name

WELLSTAR SPALDING INFUSION THERAPY - Infusion Therapy

Type

Disproportionate Share Hospital

Rural

340B ID

DSH110031A

Medicare Provider Number

110031

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/10/2024

Participating Start Date

4/1/2024

Participating Approval Date

1/18/2024

Last Recertification Date

8/28/2024

Contacts

Authorizing Official

Wellstar
Hans Meth, AVP Finance and Operations
(470) 935-4026

Primary Contact

Wellstar Health System
Sarah Oliver, 340B Program Director
(470) 956-4931

Addresses

Street Address

601 SOUTH 8TH STREET
GRIFFIN, GA 30224

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
GA	000000866A	1972535318

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH110031A	Child	DSH	WellStar Spalding Regional Hospital	WELLSTAR SPALDING INFUSION THERAPY - Infusion Therapy	601 SOUTH 8TH STREET	GRIFFIN	GA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Oliver, Sarah 340B Program Manager WellStar Health System 4709564931	Oliver, Sarah 340B Program Director Wellstar Health System 4709564931	10/15/2024 7:29 AM
Details	Last Recertification Date	Update	Recertification		8/28/2024 12:47:22 PM	8/28/2024 12:47 PM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Meth, Hans AVP Finance and Operations Wellstar 4709354026	1/18/2024 11:00 AM
Details	340B ID	Update	New Registration		DSH110031A	1/18/2024 11:00 AM
Details	Entity Name	Update	New Registration	SPALDING REGIONAL HOSPITAL	WellStar Spalding Regional Hospital	1/18/2024 11:00 AM
Details	Entity Subname	Update	New Registration	WELLSTAR SPALDING INFUSION THERAPY	WELLSTAR SPALDING INFUSION THERAPY - Infusion Therapy	1/18/2024 11:00 AM
Dates	Participating Approval Date	Update	New Registration		1/18/2024 11:00:30 AM	1/18/2024 11:00 AM
Details	State	Update	New Registration	Pending	Approved	1/18/2024 11:00 AM
Dates	Signed By Date	Update	New Registration		1/11/2024 8:53:28 AM	1/18/2024 11:00 AM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	1/18/2024 11:00 AM
Addresses	Main Address	Insert	New Registration		601 SOUTH 8TH STREET GRIFFIN, GA 30224	1/10/2024 7:34 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/10/2024 7:34 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		000000866A	1/10/2024 7:34 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		GA	1/10/2024 7:34 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1972535318	1/10/2024 7:34 PM
Medicaid Billing	NPI: State	Insert	New Registration		GA	1/10/2024 7:34 PM
Contacts	Primary Contact	Insert	New Registration		Oliver, Sarah 340B Program Manager WellStar Health System 4709564931	1/10/2024 7:34 PM
Contacts	Authorizing Official	Insert	New Registration		Meth, Hans AVP Finance and Operations Wellstar 4709354026	1/10/2024 7:34 PM
Details	Assistance Received From Date	Insert	New Registration			1/10/2024 7:34 PM
Details	Assistance Received To Date	Insert	New Registration			1/10/2024 7:34 PM
Details	Last Recertification Date	Insert	New Registration			1/10/2024 7:34 PM
Details	Grant Number	Insert	New Registration			1/10/2024 7:34 PM
Details	340B ID	Insert	New Registration			1/10/2024 7:34 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/10/2024 7:34 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/10/2024 7:34 PM
Details	Medicare Provider Number	Insert	New Registration		110031	1/10/2024 7:34 PM
Details	Entity Name	Insert	New Registration		SPALDING REGIONAL HOSPITAL	1/10/2024 7:34 PM
Details	NOFO Number	Insert	New Registration			1/10/2024 7:34 PM
Details	Program Code	Insert	New Registration		DSH	1/10/2024 7:34 PM
Details	Entity Subname	Insert	New Registration		WELLSTAR SPALDING INFUSION THERAPY	1/10/2024 7:34 PM
Dates	Participating Approval Date	Insert	New Registration			1/10/2024 7:34 PM
Details	State	Insert	New Registration		Pending	1/10/2024 7:34 PM
Dates	Registration Date	Insert	New Registration		1/10/2024 7:34:57 PM	1/10/2024 7:34 PM
Dates	Signed By Date	Insert	New Registration			1/10/2024 7:34 PM
Dates	Start Date	Insert	New Registration			1/10/2024 7:34 PM
Terminations	Termination Comments	Insert	New Registration			1/10/2024 7:34 PM
Terminations	Termination Date	Insert	New Registration			1/10/2024 7:34 PM
Terminations	Termination Effective Date	Insert	New Registration			1/10/2024 7:34 PM
Terminations	Termination Reason	Insert	New Registration			1/10/2024 7:34 PM