Covered Entity Details

DSH110054G ATRIUM HEALTH FLOYD MEDICAL CENTER (Active) - information as of 4/24/2025 12:02:33 AM

Main Details

Name

ATRIUM HEALTH FLOYD MEDICAL CENTER

Subdivision Name

BEHAVIORAL HEALTH SERVICES - OUTPATIENT ADULT

Type

Disproportionate Share Hospital

Rural

340B ID

DSH110054G

Medicare Provider Number

110054

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/12/2024

Participating Start Date

4/1/2024

Participating Approval Date

1/18/2024

Last Recertification Date

8/16/2024

Contacts

Authorizing Official

Atrium Health Floyd
Clarice Cable, AVP of Finance
(706) 509-6078

Primary Contact

Atrium Health Floyd Medical Center
Matthew Nathaniel Swords, Pharmacy Administrative Assistant
(706) 509-5929

Addresses

Street Address

306 Shorter Avenue NW
Rome, GA 30165

Billing Address

Atrium Health Floyd Medical Center
304 Turner McCall Blvd
Rome, GA 30165

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	000000756A	1154377166
AL	FLO0054P	1154377166

Shipping Addresses

Shipping Address 1

Atrium Health Floyd Medical Center
304 Turner McCall Blvd
Pharmacy
Rome, GA 30165

Shipping Address 2

Atrium Health Floyd Behavioral Health Services
306 Shorter Avenue NW
Rome, GA 30165

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
DSH110054A	Child	DSH	ATRIUM HEALTH FLOYD MEDICAL CENTER	Floyd Outpatient Surgery Center	330 Turner McCall Blvd. SW	Rome	GA	Active
DSH110054B	Child	DSH	ATRIUM HEALTH FLOYD MEDICAL CENTER	The Breast Center at Floyd	255 West Fifth St.	Rome	GA	Active
DSH110054C	Child	DSH	ATRIUM HEALTH FLOYD MEDICAL CENTER	The Family Practice Residency	304 Shorter Avenue Northwest	Rome	GA	Active
DSH110054D	Child	DSH	ATRIUM HEALTH FLOYD MEDICAL CENTER	HEYMAN HOSPICE AT FLOYD - HOSPICE	420 E 2ND AVENUE	ROME	GA	Active
DSH110054E	Child	DSH	ATRIUM HEALTH FLOYD MEDICAL CENTER	HEART FAILURE CLINIC	330 TURNER MCCALL BLVD	ROME	GA	Active
DSH110054F	Child	DSH	ATRIUM HEALTH FLOYD MEDICAL CENTER	FAMILY PRACTICE CLINIC - FAMILY PRACTICE	330 Turner McCall Blvd	Rome	GA	Active
DSH110054G	Child	DSH	ATRIUM HEALTH FLOYD MEDICAL CENTER	BEHAVIORAL HEALTH SERVICES - OUTPATIENT ADULT	306 Shorter Avenue NW	Rome	GA	Active
DSH110054H	Child	DSH	ATRIUM HEALTH FLOYD MEDICAL CENTER	FLOYD HEALTHCARE MANAGEMENT INC - EMERGENCY DEPARTMENT	13583 HIGHWAY 27	TRION	GA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		8/16/2024 7:58:38 AM	8/16/2024 7:58 AM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Cable, Clarice AVP of Finance Atrium Health Floyd 7065096078	1/18/2024 2:28 PM
Details	340B ID	Update	New Registration		DSH110054G	1/18/2024 2:28 PM
Details	Entity Name	Update	New Registration	FLOYD MEDICAL CENTER	ATRIUM HEALTH FLOYD MEDICAL CENTER	1/18/2024 2:28 PM
Details	Entity Subname	Update	New Registration	BEHAVIORAL HEALTH SERVICES	BEHAVIORAL HEALTH SERVICES - OUTPATIENT ADULT	1/18/2024 2:28 PM
Dates	Participating Approval Date	Update	New Registration		1/18/2024 2:28:37 PM	1/18/2024 2:28 PM
Details	State	Update	New Registration	Pending	Approved	1/18/2024 2:28 PM
Dates	Signed By Date	Update	New Registration		1/15/2024 9:14:50 AM	1/18/2024 2:28 PM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	1/18/2024 2:28 PM
Addresses	Main Address	Insert	New Registration		306 Shorter Avenue NW Rome, GA 30165	1/12/2024 5:43 PM
Addresses	Billing Address	Insert	New Registration		Atrium Health Floyd Medical Center 304 Turner McCall Blvd Rome, GA 30165	1/12/2024 5:43 PM
Addresses	Shipping Address	Insert	New Registration		Atrium Health Floyd Medical Center 304 Turner McCall Blvd Pharmacy Rome, GA 30165	1/12/2024 5:43 PM
Addresses	Shipping Address	Insert	New Registration		Atrium Health Floyd Behavioral Health Services 306 Shorter Avenue NW Rome, GA 30165	1/12/2024 5:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/12/2024 5:43 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		000000756A	1/12/2024 5:43 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		GA	1/12/2024 5:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/12/2024 5:43 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		FLO0054P	1/12/2024 5:43 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AL	1/12/2024 5:43 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1154377166	1/12/2024 5:43 PM
Medicaid Billing	NPI: State	Insert	New Registration		GA	1/12/2024 5:43 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1154377166	1/12/2024 5:43 PM
Medicaid Billing	NPI: State	Insert	New Registration		AL	1/12/2024 5:43 PM
Contacts	Authorizing Official	Insert	New Registration		Cable, Clarice AVP of Finance Atrium Health Floyd 7065096078	1/12/2024 5:43 PM
Contacts	Primary Contact	Insert	New Registration		Swords, Matthew Nathaniel Pharmacy Administrative Assistant Atrium Health Floyd Medical Center 7065095929	1/12/2024 5:43 PM
Details	Assistance Received From Date	Insert	New Registration			1/12/2024 5:43 PM
Details	Assistance Received To Date	Insert	New Registration			1/12/2024 5:43 PM
Details	Last Recertification Date	Insert	New Registration			1/12/2024 5:43 PM
Details	Grant Number	Insert	New Registration			1/12/2024 5:43 PM
Details	340B ID	Insert	New Registration			1/12/2024 5:43 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/12/2024 5:43 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/12/2024 5:43 PM
Details	Medicare Provider Number	Insert	New Registration		110054	1/12/2024 5:43 PM
Details	Entity Name	Insert	New Registration		FLOYD MEDICAL CENTER	1/12/2024 5:43 PM
Details	NOFO Number	Insert	New Registration			1/12/2024 5:43 PM
Details	Program Code	Insert	New Registration		DSH	1/12/2024 5:43 PM
Details	Entity Subname	Insert	New Registration		BEHAVIORAL HEALTH SERVICES	1/12/2024 5:43 PM
Dates	Participating Approval Date	Insert	New Registration			1/12/2024 5:43 PM
Details	State	Insert	New Registration		Pending	1/12/2024 5:43 PM
Dates	Registration Date	Insert	New Registration		1/12/2024 5:43:19 PM	1/12/2024 5:43 PM
Dates	Signed By Date	Insert	New Registration			1/12/2024 5:43 PM
Dates	Start Date	Insert	New Registration			1/12/2024 5:43 PM
Terminations	Termination Comments	Insert	New Registration			1/12/2024 5:43 PM
Terminations	Termination Date	Insert	New Registration			1/12/2024 5:43 PM
Terminations	Termination Effective Date	Insert	New Registration			1/12/2024 5:43 PM
Terminations	Termination Reason	Insert	New Registration			1/12/2024 5:43 PM