Covered Entity Details

DSH110054A ATRIUM HEALTH FLOYD MEDICAL CENTER (Active) - information as of 6/3/2025 12:02:27 PM

Main Details

Name

ATRIUM HEALTH FLOYD MEDICAL CENTER

Subdivision Name

Floyd Outpatient Surgery Center

Type

Disproportionate Share Hospital

Rural

340B ID

DSH110054A

Medicare Provider Number

110054

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/12/2012

Participating Start Date

1/1/2013

Participating Approval Date

11/28/2012

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

330 Turner McCall Blvd. SW
Rome, GA 30165

Billing Address

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

Floyd Medical Center
304 Turner McCall Blvd
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
DSH110054J	Child	DSH	ATRIUM HEALTH FLOYD MEDICAL CENTER	AHFMC ONCOLOGY INFUSION - Oncology Infusion	255 W 5TH ST SW	ROME	GA	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/14/2023 1:44:37 PM	8/16/2024 7:57:51 AM	8/16/2024 7:57 AM
Details	Last Recertification Date	Update	Recertification	8/26/2022 2:50:09 PM	8/14/2023 1:44:37 PM	8/14/2023 1:44 PM
Details	Entity Name	Update	Change Request	FLOYD MEDICAL CENTER	ATRIUM HEALTH FLOYD MEDICAL CENTER	10/24/2022 12:23 PM
Contacts	Primary Contact	Update	Group Change Request	Swords, Matthew Pharmacy Application Analyst Floyd Medical Center 7065095929	Swords, Matthew Nathaniel Pharmacy Administrative Assistant Atrium Health Floyd Medical Center 7065095929	10/19/2022 12:46 PM
Contacts	Authorizing Official	Update	Change Request	Cable, Edith Clarice AVP of FInance Floyd Medical Center 7065096078	Cable, Clarice AVP of Finance Atrium Health Floyd 7065096078	10/12/2022 8:33 AM
Contacts	Authorizing Official	Update	Profile Change Request	Cable, Edith Clarice Interim Chief Financial Officer Floyd Medical Center 7065096078	Cable, Edith Clarice AVP of FInance Floyd Medical Center 7065096078	8/29/2022 3:17 PM
Details	Last Recertification Date	Update	Recertification	8/23/2021 2:10:43 PM	8/26/2022 2:50:09 PM	8/26/2022 2:50 PM
Contacts	Primary Contact	Update	Change Request	Purcell, Robert A. Pharmacy Director Floyd Medical Center 7065095919	Swords, Matthew Pharmacy Application Analyst Floyd Medical Center 7065095929	1/19/2022 4:12 PM
Details	Last Recertification Date	Update	Recertification	9/1/2020 10:32:22 AM	8/23/2021 2:10:43 PM	8/23/2021 2:10 PM
Addresses	Main Address	Update	Change Request	330 Turner McCall Blvd Rome, GA 30165	330 Turner McCall Blvd. SW Rome, GA 30165	4/22/2021 12:30 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1154377166	4/22/2021 12:30 PM
Medicaid Billing	NPI: State	Insert	Change Request		AL	4/22/2021 12:30 PM
Contacts	Authorizing Official	Update	Profile Change Request	Cable, Edith Clarice Controller Floyd Medical Center 7065096078	Cable, Edith Clarice Interim Chief Financial Officer Floyd Medical Center 7065096078	9/1/2020 12:53 PM
Medicaid Billing	NPI: State	Update	Recertification		GA	9/1/2020 10:32 AM
Details	Last Recertification Date	Update	Recertification	8/29/2019 4:06:07 PM	9/1/2020 10:32:22 AM	9/1/2020 10:32 AM
Addresses	Billing Address	Insert	Change Request		Floyd Medical Center 304 Turner McCall Blvd Rome, GA 30165	1/10/2020 2:40 PM
Addresses	Shipping Address	Insert	Change Request		Floyd Medical Center 304 Turner McCall Blvd Rome, GA 30165	1/10/2020 2:40 PM
Details	Last Recertification Date	Update	Recertification	8/24/2018 1:32:16 PM	8/29/2019 4:06:07 PM	8/29/2019 4:06 PM
Medicaid Billing	Medicaid: Number	Update	Change Request	00000756A	000000756A	7/29/2019 10:42 AM
Contacts	Authorizing Official	Update	Change Request	Sheerin, Richard T. CFO Floyd Medical Center 7065096079	Cable, Edith Clarice Controller Floyd Medical Center 7065096078	7/8/2019 10:13 AM
Details	Last Recertification Date	Update	Recertification	11/29/2017 1:23:45 PM	8/24/2018 1:32:16 PM	8/24/2018 1:32 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	92513600 (FL)		4/12/2018 1:36 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	110054 (TN)		4/12/2018 1:36 PM
Details	Entity Name	Update	Recertification	Floyd Medical Center	FLOYD MEDICAL CENTER	11/29/2017 2:21 PM
Details	Last Recertification Date	Update	Recertification	8/19/2016 12:00:00 AM	11/29/2017 1:23:45 PM	11/29/2017 1:23 PM
Contacts	Authorizing Official	Update		Sheerin, Richard T. CFO 7065096079	Sheerin, Richard T. CFO Floyd Medical Center 7065096079	10/10/2017 3:17 PM
Contacts	Signed By	Update		Sheerin, Richard T. CFO 7065096079	Sheerin, Richard T. CFO Floyd Medical Center 7065096079	10/10/2017 3:17 PM
Contacts	Primary Contact	Update		Purcell, Robert A. Pharmacy Director 7065095919	Purcell, Robert A. Pharmacy Director Floyd Medical Center 7065095919	9/25/2017 9:32 AM
Contacts	Authorizing Official	Insert			Sheerin, Richard T. CFO 7065096079	8/19/2016 9:09 AM
Contacts	Signed By	Insert			Sheerin, Richard T. CFO 7065096079	8/19/2016 9:09 AM
Contacts	Primary Contact	Insert			Purcell, Robert A. Pharmacy Director 7065095919	8/19/2016 9:09 AM
Details	Last Recertification Date	Update		8/11/2015 12:00:00 AM	8/19/2016 12:00:00 AM	8/19/2016 9:09 AM
Addresses	Main Address	Insert			330 Turner McCall Blvd Rome, GA 30165	8/19/2016 9:09 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/25/2015 1:53 PM
Medicaid Billing	Medicaid: Number	Insert			FLO0054P	8/25/2015 1:53 PM
Medicaid Billing	Medicaid: State	Insert			AL	8/25/2015 1:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/25/2015 1:53 PM
Medicaid Billing	Medicaid: Number	Insert			92513600	8/25/2015 1:53 PM
Medicaid Billing	Medicaid: State	Insert			FL	8/25/2015 1:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/25/2015 1:53 PM
Medicaid Billing	Medicaid: Number	Insert			110054	8/25/2015 1:53 PM
Medicaid Billing	Medicaid: State	Insert			TN	8/25/2015 1:53 PM
Medicaid Billing	NPI: Number	Insert			1154377166	8/25/2015 1:53 PM
Details	Last Recertification Date	Update		9/3/2014 12:00:00 AM	8/11/2015 12:00:00 AM	8/11/2015 10:14 AM
Details	Last Recertification Date	Update		9/11/2013 3:57:44 PM	9/3/2014 12:00:00 AM	9/3/2014 2:27 PM
Details	Last Recertification Date	Update			9/11/2013 3:57:44 PM	9/11/2013 3:57 PM
Details	340B ID	Update		IS-DR-DSH110054A	DSH110054A	11/28/2012 9:37 AM
Dates	Participating Approval Date	Update			11/28/2012 12:00:00 AM	11/28/2012 9:37 AM
Details	State	Update		Pending	Active	11/28/2012 9:37 AM
Dates	Start Date	Update			1/1/2013 12:00:00 AM	11/28/2012 9:37 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	IS-DR-DSH110054A	11/16/2012 10:11 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/12/2012 5:32 PM
Medicaid Billing	Medicaid: Number	Insert			00000756A	10/12/2012 5:32 PM
Medicaid Billing	Medicaid: State	Insert			GA	10/12/2012 5:32 PM
Details	Last Recertification Date	Insert				10/12/2012 5:32 PM
Details	Grant Number	Insert				10/12/2012 5:32 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	10/12/2012 5:32 PM
Details	Is Authorizing Official EHB Data	Insert				10/12/2012 5:32 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/12/2012 5:32 PM
Details	Medicare Provider Number	Insert			110054	10/12/2012 5:32 PM
Details	Entity Name	Insert			Floyd Medical Center	10/12/2012 5:32 PM
Details	Program Code	Insert			DSH	10/12/2012 5:32 PM
Details	Entity Subname	Insert			Floyd Outpatient Surgery Center	10/12/2012 5:32 PM
Dates	Participating Approval Date	Insert				10/12/2012 5:32 PM
Details	State	Insert			Pending	10/12/2012 5:32 PM
Dates	Registration Date	Insert			10/12/2012 12:00:00 AM	10/12/2012 5:32 PM
Dates	Signed By Date	Insert			10/12/2012 12:00:00 AM	10/12/2012 5:32 PM
Dates	Start Date	Insert				10/12/2012 5:32 PM
Terminations	Termination Comments	Insert				10/12/2012 5:32 PM
Terminations	Termination Date	Insert				10/12/2012 5:32 PM
Terminations	Termination Effective Date	Insert				10/12/2012 5:32 PM
Terminations	Termination Reason	Insert				10/12/2012 5:32 PM