340B Drug Pricing Program Database


DSH110122 SOUTH GEORGIA MEDICAL CENTER (Active) - information as of 4/24/2025 11:12:57 PM

Main Details
SOUTH GEORGIA MEDICAL CENTER
Disproportionate Share Hospital
No
DSH110122
110122


Additional Details
Active
4/15/2008
7/1/2004
4/15/2008
8/23/2024

Contacts

SGMC
Ronald E Dean, CEO
(229) 259-4102

SGMC
Scott Bruce Smith, Director of Pharmacy
(229) 259-4870

Addresses

2501 NORTH PATTERSON STREET
VALDOSTA, GA 31602

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
GA000001724G,000001724A1306896253,1528049046,1144096553
FL1109617-00,0102075-001306896253,1528049046,1144096553
Shipping Addresses

Same as Street Address
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
DURHAMNC2771311/30/202211/30/2022  11/30/2022
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526111/30/202211/30/2022  11/30/2022
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267010/07/202401/01/2025  01/01/2025
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620310/07/202401/01/2025  01/01/2025
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522610/07/202401/01/2025  01/01/2025
Contract DetailDOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K 		GREENVILLESC29607-654111/30/202211/30/2022  11/30/2022
Contract DetailRAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255011/30/202211/30/2022  11/30/2022
Contract DetailRIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500211/30/202211/30/2022  11/30/2022
Contract DetailSANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301310/07/202401/01/2025  01/01/2025
Contract DetailSINA DRUG LLCDBA ONCO360 1985 MARCUS AVE STE 120
NEW HYDE PARKNY1104210/07/202401/01/2025  01/01/2025
Contract DetailSINA DRUG LLCD/B/A ONCO 360 13410 EASTPOINT CENTRE DR
STE 101 		LOUISVILLEKY4022310/07/202401/01/2025  01/01/2025
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH110122AChildDSHSOUTH GEORGIA MEDICAL CENTERTHE SURGERY CENTER2417 NORTH PATTERSON STREETVALDOSTAGAActive
DSH110122BChildDSHSOUTH GEORGIA MEDICAL CENTERHealth Care South250 Griffin AvenueValdostaGATerminated
DSH110122CChildDSHSOUTH GEORGIA MEDICAL CENTERImaging Center2409 North Patterson StreetValdostaGAActive
DSH110122DChildDSHSOUTH GEORGIA MEDICAL CENTERDiabetes Management Center3018 North Patterson StreetValdostaGATerminated
DSH110122EChildDSHSOUTH GEORGIA MEDICAL CENTERWound Care2330 North Ashley StreetValdostaGATerminated
DSH110122FChildDSHSOUTH GEORGIA MEDICAL CENTERSmith Northview Hospital4280 North Valdosta RoadValdostaGATerminated
DSH110122GChildDSHSOUTH GEORGIA MEDICAL CENTERSmithNorthview Hospital4280 North Valdosta RoadValdostaGAActive
DSH110122HChildDSHSOUTH GEORGIA MEDICAL CENTERSGMC SMITH NORTHVIEW - SNH OR4280 N VALDOSTA RDVALDOSTAGAActive
DSH110122JChildDSHSOUTH GEORGIA MEDICAL CENTERSGMC SMITH NORTHVIEW - SNH CT Scan4280 N VALDOSTA RDVALDOSTAGAActive
DSH110122KChildDSHSOUTH GEORGIA MEDICAL CENTERSGMC SMITH NORTHVIEW - SNH Wound and Burn Care4280 N VALDOSTA RDVALDOSTAGAActive
DSH110122LChildDSHSOUTH GEORGIA MEDICAL CENTERSGMC SMITH NORTHVIEW - SNH MRI4280 N VALDOSTA RDVALDOSTAGAActive
DSH110122MChildDSHSOUTH GEORGIA MEDICAL CENTERSGMC SMITH NORTHVIEW - SNH Endoscopy4280 N VALDOSTA RDVALDOSTAGAActive
DSH110122NChildDSHSOUTH GEORGIA MEDICAL CENTERSGMC SMITH NORTHVIEW - SNH Infusion4280 N VALDOSTA RDVALDOSTAGAActive
DSH110122PChildDSHSOUTH GEORGIA MEDICAL CENTERSGMC SMITH NORTHVIEW - SNH Anesthesia4280 N VALDOSTA RDVALDOSTAGAActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False8/23/2024 6:38 AM
Medicaid BillingMedicaid: NumberInsertRecertification 000001724G8/23/2024 6:38 AM
Medicaid BillingMedicaid: StateInsertRecertification GA8/23/2024 6:38 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False8/23/2024 6:38 AM
Medicaid BillingMedicaid: NumberInsertRecertification 1109617-008/23/2024 6:38 AM
Medicaid BillingMedicaid: StateInsertRecertification FL8/23/2024 6:38 AM
DetailsLast Recertification DateUpdateRecertification8/23/2023 3:43:20 PM8/23/2024 6:38:04 AM8/23/2024 6:38 AM
Medicaid BillingNPI: NumberInsertChange Request 11440965531/18/2024 1:15 PM
Medicaid BillingNPI: StateInsertChange Request GA1/18/2024 1:15 PM
Medicaid BillingNPI: NumberInsertChange Request 11440965531/18/2024 1:15 PM
Medicaid BillingNPI: StateInsertChange Request FL1/18/2024 1:15 PM
DetailsLast Recertification DateUpdateRecertification9/7/2022 1:27:18 PM8/23/2023 3:43:20 PM8/23/2023 3:43 PM
DetailsLast Recertification DateUpdateRecertification9/10/2021 7:33:25 AM9/7/2022 1:27:18 PM9/7/2022 1:27 PM
DetailsLast Recertification DateUpdateRecertification9/7/2020 9:48:55 AM9/10/2021 7:33:25 AM9/10/2021 7:33 AM
ContactsAuthorizing OfficialUpdateChange RequestByers, Grant D CFO SGMC 2292594162Dean, Ronald E CEO SGMC 22925941023/7/2021 2:04 PM
Medicaid BillingNPI: NumberInsertChange Request 130689625312/14/2020 3:24 PM
Medicaid BillingNPI: StateInsertChange Request FL12/14/2020 3:24 PM
Medicaid BillingNPI: NumberInsertChange Request 152804904612/14/2020 3:24 PM
Medicaid BillingNPI: StateInsertChange Request FL12/14/2020 3:24 PM
ContactsAuthorizing OfficialUpdateChange RequestDean, Ronald E CEO SGMC 2292594102Byers, Grant D CFO SGMC 229259416212/14/2020 3:24 PM
Medicaid BillingNPI: NumberDeleteRecertification1528049046 ( ) 9/7/2020 9:48 AM
Medicaid BillingNPI: NumberInsertRecertification 13068962539/7/2020 9:48 AM
Medicaid BillingNPI: StateInsertRecertification GA9/7/2020 9:48 AM
Medicaid BillingNPI: NumberInsertRecertification 15280490469/7/2020 9:48 AM
Medicaid BillingNPI: StateInsertRecertification GA9/7/2020 9:48 AM
Medicaid BillingNPI: NumberDeleteRecertification1306896253 ( ) 9/7/2020 9:48 AM
DetailsLast Recertification DateUpdateRecertification9/9/2019 6:14:44 AM9/7/2020 9:48:55 AM9/7/2020 9:48 AM
Medicaid BillingNPI: NumberInsertChange Request 15280490463/30/2020 2:05 PM
ContactsAuthorizing OfficialUpdateChange RequestForbes, Bill CEO South Georgia Medical Ct. 2292594175Dean, Ronald E CEO SGMC 229259410212/20/2019 10:29 AM
DetailsLast Recertification DateUpdateRecertification8/23/2018 2:16:51 PM9/9/2019 6:14:44 AM9/9/2019 6:14 AM
DetailsLast Recertification DateUpdateRecertification11/21/2017 12:37:35 PM8/23/2018 2:16:51 PM8/23/2018 2:16 PM
ContactsAuthorizing OfficialUpdateAO Change RequestBerry, C. Ross CEO South Georgia Medical Center 2292594102Forbes, Bill CEO South Georgia Medical Ct. 22925941758/20/2018 2:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/8/2018 10:33 AM
Medicaid BillingMedicaid: NumberInsertChange Request 000001724A6/8/2018 10:33 AM
Medicaid BillingMedicaid: StateInsertChange Request GA6/8/2018 10:33 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/8/2018 10:33 AM
Medicaid BillingMedicaid: NumberInsertChange Request 0102075-006/8/2018 10:33 AM
Medicaid BillingMedicaid: StateInsertChange Request FL6/8/2018 10:33 AM
Medicaid BillingNPI: NumberInsertChange Request 13068962536/8/2018 10:33 AM
ContactsPrimary ContactUpdateChange RequestWoodard, Todd Director of Pharmacy South Georgia Medical Center 2292594408Smith, Scott Bruce Director of Pharmacy SGMC 22925948706/8/2018 10:33 AM
ContactsPrimary ContactInsertRecertification Woodard, Todd Director of Pharmacy South Georgia Medical Center 229259440811/21/2017 12:37 PM
DetailsLast Recertification DateUpdateRecertification9/1/2016 12:00:00 AM11/21/2017 12:37:35 PM11/21/2017 12:37 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestBerry, Ross C. CEO South Georgia Medical Center 2292594102Berry, C. Ross CEO South Georgia Medical Center 229259410210/26/2017 10:05 AM
ContactsAuthorizing OfficialUpdate Berry, Ross C. CEO 2292594102Berry, Ross C. CEO South Georgia Medical Center 229259410210/23/2017 3:16 PM
ContactsAuthorizing OfficialUpdate Evans, Heath A. Interim CEO 2292594102Berry, Ross C. CEO 22925941026/14/2017 11:21 AM
AddressesMain AddressInsert   2501 NORTH PATTERSON STREET VALDOSTA, GA 316026/14/2017 11:21 AM
ContactsAuthorizing OfficialUpdate Snead Jr., Raymond A. Chief Executive Officer 2292594102Evans, Heath A. Interim CEO 22925941025/12/2017 11:34 AM
ContactsAuthorizing OfficialUpdate HEMBREE, GREG CFO 2292594160Snead Jr., Raymond A. Chief Executive Officer 22925941029/6/2016 4:34 PM
DetailsLast Recertification DateUpdate 9/2/2015 12:00:00 AM9/1/2016 12:00:00 AM9/6/2016 4:34 PM
DetailsLast Recertification DateUpdate 8/22/2014 12:00:00 AM9/2/2015 12:00:00 AM9/3/2015 3:21 PM
DetailsLast Recertification DateUpdate 9/13/2013 12:00:00 AM8/22/2014 12:00:00 AM8/22/2014 8:09 AM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/13/2013 12:00:00 AM9/13/2013 9:06 AM
ContactsAuthorizing OfficialInsert  HEMBREE, GREG CFO 22925941605/15/2012 7:26 AM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/15/2012 7:26 AM
DatesParticipating Approval DateUpdate 4/15/2008 11:52:02 AM4/15/2008 12:00:00 AM3/19/2012 12:04 PM
DetailsLast Recertification DateInsert   4/15/2008 11:55 AM
DetailsGrant NumberInsert   4/15/2008 11:55 AM
Details340B IDInsert  DSH1101224/15/2008 11:55 AM
DetailsIs Authorizing Official EHB DataInsert   4/15/2008 11:55 AM
DatesLast Date That 340B Drugs PurchasedInsert   4/15/2008 11:55 AM
DetailsMedicare Provider NumberInsert  1101224/15/2008 11:55 AM
DetailsEntity NameInsert  SOUTH GEORGIA MEDICAL CENTER4/15/2008 11:55 AM
DetailsProgram CodeInsert  DSH4/15/2008 11:55 AM
DetailsEntity SubnameInsert   4/15/2008 11:55 AM
DatesParticipating Approval DateInsert  4/15/2008 11:52:02 AM4/15/2008 11:55 AM
DetailsStateInsert  Active4/15/2008 11:55 AM
DatesRegistration DateInsert  4/15/2008 12:00:00 AM4/15/2008 11:55 AM
DatesSigned By DateInsert   4/15/2008 11:55 AM
DatesStart DateInsert  7/1/2004 12:00:00 AM4/15/2008 11:55 AM
TerminationsTermination CommentsInsert   4/15/2008 11:55 AM
TerminationsTermination DateInsert   4/15/2008 11:55 AM
TerminationsTermination Effective DateInsert   4/15/2008 11:55 AM
TerminationsTermination ReasonInsert   4/15/2008 11:55 AM