340B Drug Pricing Program Database


DSH110015 TANNER MEDICAL CENTER/VILLA RICA (Active) - information as of 5/17/2025 10:50:52 PM

Main Details
TANNER MEDICAL CENTER/VILLA RICA
Disproportionate Share Hospital
No
DSH110015
110015


Additional Details
Active
4/11/2008
7/1/2005
4/11/2008
8/30/2024

Contacts

Tanner Health System
Carol S. Crews, CFO
(770) 812-9745

Tanner Health System
Emily Renee Allen, 340B Program Manager
(770) 812-8371

Addresses

601 DALLAS ROAD
VILLA RICA, GA 30180

TANNER MEDICAL CENTER, Inc.
ATTN: ACCOUNTS PAYABLE
100 Greenway Blvd
Suite A
CARROLLTON, GA 30117


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
5/27/09 DOC RECD TO CONFIRM ELIG DSH ADJ%; 3/6/07 ADDR CHANGE (WAS 707 DALLAS HIGHWAY), REMOVED PO BOX06/15/2009
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
GA000002032A,003238990A1851388748,1679195606
ALHOS0015P1679195606,1851388748
Shipping Addresses

TANNER MEDICAL CENTER/VILLA RICA
705 DALLAS HWY STE 302
VILLA RICA, GA 30180

NW GA ONCOLOGY CENTER CLINIC PHCY-TMC-VR
157 CLINIC AVE STE 101
CARROLLTON, GA 30117

NW GA ONCOLOGY CENTER RETAIL PHCY-TMC-VR
157 CLINIC AVE STE 202 ROOM 219
CARROLLTON, GA 30117

SAFECOR HEALTH LLC
317 NEW BOSTON ST
STE 100
WOBURN, MA 01801
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771310/16/202301/01/2024  01/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526110/16/202301/01/2024  01/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267010/16/202301/01/2024  01/01/2024
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/15/202210/01/2022  10/01/2022
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/15/202210/01/2022  10/01/2022
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/15/202210/01/2022  10/01/2022
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/15/202210/01/2022  10/01/2022
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/15/202210/01/2022  10/01/2022
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/15/202210/01/2022  10/01/2022
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/15/202210/01/2022  10/01/2022
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813307/15/202210/01/2022  10/01/2022
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237407/15/202210/01/2022  10/01/2022
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/15/202210/01/2022  10/01/2022
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/15/202210/01/2022  10/01/2022
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/15/202210/01/2022  10/01/2022
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/15/202210/01/2022  10/01/2022
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503307/15/202210/01/2022  10/01/2022
Contract DetailDOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K 		GREENVILLESC29607-654110/16/202301/01/2024  01/01/2024
Contract DetailGEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04576 107 SPRING ST.
TALLAPOOSAGA3017607/15/202210/01/2022  10/01/2022
Contract DetailGEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05765 100 OAK ST
BOWDONGA3010807/15/202210/01/2022  10/01/2022
Contract DetailGEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07721 206 ALABAMA AVE,
BREMENGA3011007/15/202210/01/2022  10/01/2022
Contract DetailGEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04568 546 BANKHEAD HIGHWAY
CARROLLTONGA3011707/15/202210/01/2022  10/01/2022
Contract DetailGEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05637 736 W BANKHEAD HWY
VILLA RICAGA3018007/15/202210/01/2022  10/01/2022
Contract DetailGEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04532 2125 MAPLE ST.
CARROLLTONGA3011707/15/202210/01/2022  10/01/2022
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/15/202210/01/2022  10/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681307/15/202210/01/2022  10/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523307/15/202210/01/2022  10/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920307/15/202210/01/2022  10/01/2022
Contract DetailRAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255010/16/202301/01/2024  01/01/2024
Contract DetailRIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500210/16/202301/01/2024  01/01/2024
Contract DetailSANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301310/16/202301/01/2024  01/01/2024
Contract DetailTANNER RETAIL PHARMACY706 DIXIE ST STE 140
CARROLLTONGA30117-385904/15/202407/01/2024  07/01/2024
Contract DetailWALGREEN CODBA: WALGREENS #7741 2154 JOHNSON FERRY RD NE
BROOKHAVENGA3031907/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CODBA: WALGREENS #11491 684 W BANKHEAD HWY
VILLA RICAGA3018007/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CODBA: WALGREENS #10968 5000 FLOYD ROAD SW
MABLETONGA3012607/15/202210/01/2022 04/24/202504/24/2025
Contract DetailWALGREEN CO.DBA: WALGREENS #17278 211 TEMPLE AVE
NEWNANGA3026307/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 06371 880 GLYNN STREET SOUTH
FAYETTEVILLEGA3021407/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #02454 3116 HWY 34 EAST
NEWNANGA3026507/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 06461 1762 MARS HILL RD NW
ACWORTHGA30101-809107/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WIGGINS FAMILY PHARMACY 1128 S PARK ST
CARROLLTONGA3011707/15/202210/01/2022 08/21/202309/02/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 05902 2670 COBB PARKWAY SE
SMYRNAGA3008007/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.WALGREENS #17037 2020 HOWELL MILL RD NW
ATLANTAGA30318-173207/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 06325 5230 DALLAS HWY
POWDER SPRINGSGA3012707/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 10422 3658 ROSWELL RD NW
ATLANTAGA3034207/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 06207 5985 PEACHTREE PKWY
NORCROSSGA3009207/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 07167 5511 CHAMBLEE DUNWOODY RD SUITE A
DUNWOODYGA30338-410607/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.COMMUNITY A WALGREENS PHARMACY #15304 1874 PIEDMONT AVE NE STE 100A
ATLANTAGA3032407/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 02455 2580 SANDY PLAINS ROAD
MARIETTAGA30066-579807/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 09303 2893 PEACHTREE RD NE
ATLANTAGA30305-292907/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #13759 6120 OLD NATIONAL HWY
COLLEGE PARKGA3034907/15/202210/01/2022 04/22/202504/22/2025
Contract DetailWALGREEN CO.DBA: WALGREENS #11685 201 PACIFIC AVENUE
BREMENGA3011007/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.WALGREENS SPECIALTY PHARMACY #13641 35 COLLIER ROAD NW SUITE 100
ATLANTAGA3030907/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.WALGREENS #17194 3687 HIGHWAY 5
DOUGLASVILLEGA3013507/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #11757 3925 PEACHTREE RD NE
BROOKHAVENGA3031907/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #10854 2701 FAIRBURN RD
DOUGLASVILLEGA30135-294107/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 06204 7530 ROSWELL RD
ATLANTAGA30350-483707/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 07394 3740 CASCADE RD SW
ATLANTAGA3033107/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 09451 5510 WINDWARD PKWY
ALPHARETTAGA3000407/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 01646 23 S MARIETTA PKWY SW
MARIETTAGA30064-328807/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 07960 1065 DULUTH HIGHWAY
LAWRENCEVILLEGA30043-521607/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.WALGREENS #19823 2498 CUMBERLAND PKWY SE
ATLANTAGA3033907/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 07395 6410 W JOHNS CROSSING
DULUTHGA3009707/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 05901 2390 S COBB DRIVE SE
SMYRNAGA3008007/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.WALGREENS #19047 2345 PEACHTREE RD NE
ATLANTAGA3030507/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 05760 3003 OLD ALABAMA RD
ALPHARETTAGA3002207/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 02359 5373 PEACHTREE INDUSTRIAL BLVD
CHAMBLEEGA30341-213907/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 09452 855 VETERANS MEMORIAL HWY SE
MABLETONGA3012607/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 05758 4371 S COBB DR SE
SMYRNAGA3008007/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 06032 595 PIEDMONT AVE NE STE 100
ATLANTAGA30308-248007/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.WALGREENS #17033 4692 RIDGE RD
DOUGLASVILLEGA3013407/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 07820 794 SOUTH PARK ST
CARROLLTONGA30117-382507/15/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 06330 2464 ROSWELL RD.
MARIETTAGA3006207/15/202210/01/2022  10/01/2022
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527507/15/202210/01/2022  10/01/2022
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503307/15/202210/01/2022  10/01/2022
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818807/15/202210/01/2022  10/01/2022
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH110015AChildDSHTANNER MEDICAL CENTER/VILLA RICATANNER HEALTH MS INFUSION CENTER3200 DOWNWOOD CIRCLE NWATLANTAGAActive
DSH110015BChildDSHTANNER MEDICAL CENTER/VILLA RICAWEST GEORGIA INFUSION SERVICES - INFUSION CENTER157 CLINIC AVENUECARROLLTONGAActive
DSH110015CChildDSHTANNER MEDICAL CENTER/VILLA RICANorthwest Georgia Oncology Centers - Carrollton - Oncology157 Clinic AveCarrolltonGAApproved
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsPrimary ContactUpdatePC Change RequestMiller, Emily 340B Program Manager Tanner Health System 7708128371Allen, Emily Renee 340B Program Manager Tanner Health System 77081283712/7/2025 2:00 PM
AddressesShipping AddressInsertChange Request SAFECOR HEALTH LLC 317 NEW BOSTON ST STE 100 WOBURN, MA 018019/6/2024 12:48 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False9/6/2024 12:48 PM
Medicaid BillingMedicaid: NumberInsertChange Request HOS0015P9/6/2024 12:48 PM
Medicaid BillingMedicaid: StateInsertChange Request AL9/6/2024 12:48 PM
Medicaid BillingNPI: NumberInsertChange Request 16791956069/6/2024 12:48 PM
Medicaid BillingNPI: StateInsertChange Request AL9/6/2024 12:48 PM
Medicaid BillingNPI: NumberInsertChange Request 18513887489/6/2024 12:48 PM
Medicaid BillingNPI: StateInsertChange Request AL9/6/2024 12:48 PM
AddressesBilling AddressUpdateRecertificationTANNER MEDICAL CENTER-VILLA RICA ATTN: ACCOUNTS PAYABLE 109 CEDAR STREET Suite A CARROLLTON, GA 30117TANNER MEDICAL CENTER, Inc. ATTN: ACCOUNTS PAYABLE 100 Greenway Blvd Suite A CARROLLTON, GA 301178/30/2024 7:30 AM
DetailsLast Recertification DateUpdateRecertification9/5/2023 6:54:05 AM8/30/2024 7:30:08 AM8/30/2024 7:30 AM
ContactsPrimary ContactUpdateGroup Change RequestBarrett, Lynn Director of Pharmacy Tanner Medical Center 7708369646Miller, Emily 340B Program Manager Tanner Health System 77081283713/14/2024 3:30 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False9/13/2023 5:12 PM
Medicaid BillingMedicaid: NumberInsertChange Request 003238990A9/13/2023 5:12 PM
Medicaid BillingMedicaid: StateInsertChange Request GA9/13/2023 5:12 PM
Medicaid BillingNPI: NumberInsertChange Request 16791956069/13/2023 5:12 PM
Medicaid BillingNPI: StateInsertChange Request GA9/13/2023 5:12 PM
DetailsLast Recertification DateUpdateRecertification9/7/2022 10:29:35 AM9/5/2023 6:54:05 AM9/5/2023 6:54 AM
DetailsLast Recertification DateUpdateRecertification8/30/2021 12:12:22 PM9/7/2022 10:29:35 AM9/7/2022 10:29 AM
DetailsLast Recertification DateUpdateRecertification9/3/2020 12:52:14 PM8/30/2021 12:12:22 PM8/30/2021 12:12 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/15/2021 12:24 PM
Medicaid BillingMedicaid: NumberInsertChange Request 000002032A1/15/2021 12:24 PM
Medicaid BillingMedicaid: StateInsertChange Request GA1/15/2021 12:24 PM
Medicaid BillingMedicaid: NumberDeleteChange Request2032A0 (GA) 1/15/2021 12:24 PM
Medicaid BillingNPI: NumberDeleteRecertification1851388748 ( ) 9/3/2020 12:52 PM
Medicaid BillingNPI: NumberInsertRecertification 18513887489/3/2020 12:52 PM
Medicaid BillingNPI: StateInsertRecertification GA9/3/2020 12:52 PM
DetailsLast Recertification DateUpdateRecertification9/2/2019 2:00:50 PM9/3/2020 12:52:14 PM9/3/2020 12:52 PM
AddressesShipping AddressInsertChange Request NW GA ONCOLOGY CENTER CLINIC PHCY-TMC-VR 157 CLINIC AVE STE 101 CARROLLTON, GA 301176/26/2020 5:18 PM
AddressesShipping AddressInsertChange Request NW GA ONCOLOGY CENTER RETAIL PHCY-TMC-VR 157 CLINIC AVE STE 202 ROOM 219 CARROLLTON, GA 301176/26/2020 5:18 PM
AddressesShipping AddressInsertChange Request TANNER MEDICAL CENTER/VILLA RICA 705 DALLAS HWY STE 302 VILLA RICA, GA 301806/2/2020 3:55 PM
DetailsLast Recertification DateUpdateRecertification9/2/2018 12:00:01 AM9/2/2019 2:00:50 PM9/2/2019 2:00 PM
AddressesBilling AddressInsertRecertification TANNER MEDICAL CENTER-VILLA RICA ATTN: ACCOUNTS PAYABLE 109 CEDAR STREET Suite A CARROLLTON, GA 301179/2/2018 12:00 AM
DetailsLast Recertification DateUpdateRecertification12/4/2017 6:34:22 AM9/2/2018 12:00:01 AM9/2/2018 12:00 AM
DetailsLast Recertification DateUpdateRecertification8/29/2016 12:00:00 AM12/4/2017 6:34:22 AM12/4/2017 6:34 AM
ContactsAuthorizing OfficialUpdate Crews, Carol S. CFO 7708129745Crews, Carol S. CFO Tanner Health System 770812974510/11/2017 2:57 PM
ContactsPrimary ContactUpdate Barrett, Lynn Director of Pharmacy 7708369646Barrett, Lynn Director of Pharmacy Tanner Medical Center 77083696469/29/2017 9:16 AM
ContactsPrimary ContactInsert  Barrett, Lynn Director of Pharmacy 77083696462/21/2017 1:47 PM
ContactsAuthorizing OfficialInsert  Crews, Carol S. CFO 77081297452/21/2017 1:47 PM
AddressesMain AddressInsert   601 DALLAS ROAD VILLA RICA, GA 301808/29/2016 6:06 PM
DetailsLast Recertification DateUpdate 8/12/2015 12:00:00 AM8/29/2016 12:00:00 AM8/29/2016 6:06 PM
Medicaid BillingMedicaid: Is PrimaryUpdate TrueFalse8/12/2015 11:58 PM
DetailsLast Recertification DateUpdate 9/4/2014 12:00:00 AM8/12/2015 12:00:00 AM8/12/2015 11:58 PM
DetailsLast Recertification DateUpdate 9/4/2013 12:00:00 AM9/4/2014 12:00:00 AM9/4/2014 2:20 PM
Medicaid BillingNPI: NumberInsert  18513887489/4/2013 11:13 AM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/4/2013 12:00:00 AM9/4/2013 11:13 AM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/16/2012 7:43 AM
DetailsLast Recertification DateInsert   6/15/2009 2:15 PM
DetailsGrant NumberInsert   6/15/2009 2:15 PM
Details340B IDInsert  DSH1100156/15/2009 2:15 PM
DetailsIs Authorizing Official EHB DataInsert   6/15/2009 2:15 PM
DatesLast Date That 340B Drugs PurchasedInsert   6/15/2009 2:15 PM
DetailsMedicare Provider NumberInsert  1100156/15/2009 2:15 PM
DetailsEntity NameInsert  TANNER MEDICAL CENTER/VILLA RICA6/15/2009 2:15 PM
DetailsProgram CodeInsert  DSH6/15/2009 2:15 PM
DetailsEntity SubnameInsert   6/15/2009 2:15 PM
DatesParticipating Approval DateInsert  4/11/2008 12:00:00 AM6/15/2009 2:15 PM
DetailsStateInsert  Active6/15/2009 2:15 PM
DatesRegistration DateInsert  4/11/2008 12:00:00 AM6/15/2009 2:15 PM
DatesSigned By DateInsert  5/28/2005 12:00:00 AM6/15/2009 2:15 PM
DatesStart DateInsert  7/1/2005 12:00:00 AM6/15/2009 2:15 PM
TerminationsTermination CommentsInsert   6/15/2009 2:15 PM
TerminationsTermination DateInsert   6/15/2009 2:15 PM
TerminationsTermination Effective DateInsert   6/15/2009 2:15 PM
TerminationsTermination ReasonInsert   6/15/2009 2:15 PM
DetailsComments PublicInsert  5/27/09 DOC RECD TO CONFIRM ELIG DSH ADJ%; 3/6/07 ADDR CHANGE (WAS 707 DALLAS HIGHWAY), REMOVED PO BOX6/15/2009 2:15 PM
Medicaid BillingMedicaid: Is PrimaryInsert  True4/11/2008 11:56 AM
Medicaid BillingMedicaid: NumberInsert  2032A04/11/2008 11:56 AM
Medicaid BillingMedicaid: StateInsert  GA4/11/2008 11:56 AM