Covered Entity Details

DSH110034E AU Medical Center, Inc. (Active) - information as of 6/17/2025 11:41:10 PM

Main Details

Name

AU Medical Center, Inc.

Subdivision Name

Georgia Radiation Therapy Center

Type

Disproportionate Share Hospital

Rural

340B ID

DSH110034E

Medicare Provider Number

110034

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/9/2015

Participating Start Date

4/1/2015

Participating Approval Date

3/4/2015

Last Recertification Date

8/22/2024

Contacts

Authorizing Official

AU Medical Center, Inc.
Jennifer Moore Miller, VP, Strategy and Business Development
(706) 721-5250

Primary Contact

AU Medical Center, Inc.
Gerard Schick, Business Operations and 340B Manager
(706) 721-3979

Addresses

Street Address

821 St. Sebastian Way
Augusta, GA 30912

Billing Address

AU Medical Center, Inc.
1120 15th Street
Augusta, GA 30912

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
SC	7G0130,358127,7Z1204,7Z1203	1437135902,1487901476,1760886808,1558028308
GA	003160189A,003159433A,000000723A,003272120A	1437135902,1487901476,1760886808,1558028308

Shipping Addresses

Shipping Address 1

AU Medical Center, Inc.
1120 15th Street
Augusta, GA 30912

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
DSH110034A	Child	DSH	AU Medical Center, Inc.	Georgia Cancer Center	1411 LANEY WALKER BLVD	AUGUSTA	GA	Active
DSH110034B	Child	DSH	AU Medical Center, Inc.	ASMP - Infectious Disease Clinic	3001 Gordon Highway	GROVETOWN	GA	Terminated
DSH110034C	Child	DSH	AU Medical Center, Inc.	Digestive Health Center	1481 Laney Walker Boulevard	Augusta	GA	Terminated
DSH110034D	Child	DSH	AU Medical Center, Inc.	Cardiovascular Center Chafee Ave	1003 Chafee Avenue	Augusta	GA	Active
DSH110034E	Child	DSH	AU Medical Center, Inc.	Georgia Radiation Therapy Center	821 St. Sebastian Way	Augusta	GA	Active
DSH110034F	Child	DSH	AU Medical Center, Inc.	Neurology Building	905 15th Street	Augusta	GA	Active
DSH110034G	Child	DSH	AU Medical Center, Inc.	Psychiatry Clinic	997 St. Sebastian Way	Augusta	GA	Active
DSH110034H	Child	DSH	AU Medical Center, Inc.	Cardiovascular Center 15th Street	937 15th Street	Augusta	GA	Active
DSH110034J	Child	DSH	AU Medical Center, Inc.	ASMP / Oncology Clinic	3001 Gordon Highway	Grovetown	GA	Terminated
DSH110034K	Child	DSH	AU Medical Center, Inc.	GEORGIA CANCER CENTER -AIKEN - Oncology	1348 WALTON WAY	AUGUSTA	GA	Terminated
DSH110034L	Child	DSH	AU Medical Center, Inc.	Georgia Cancer Center - Downtown Augusta	818 SAINT SEBASTIAN WAY	AUGUSTA	GA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 4:38:11 PM	8/22/2024 8:37:34 AM	8/22/2024 8:37 AM
Contacts	Primary Contact	Update	Change Request	Schick, Gerard Kristopher Business Operations Manager AU Medical Center, Inc 7067213979	Schick, Gerard Business Operations and 340B Manager AU Medical Center, Inc. 7067213979	7/24/2024 11:05 AM
Contacts	Authorizing Official	Update	AO Change Request	Miller, Jennifer Chief Strategy Officer AU Medical Center, Inc. 7068367051	Miller, Jennifer Moore VP, Strategy and Business Development AU Medical Center, Inc. 7067215250	7/15/2024 1:10 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	003242979A (GA)		3/4/2024 9:41 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1033716915 (GA)		3/4/2024 9:41 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1033716915 (SC)		3/4/2024 9:41 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	003272835B (GA)		8/15/2023 4:38 PM
Details	Last Recertification Date	Update	Recertification	8/26/2022 12:07:03 PM	8/15/2023 4:38:11 PM	8/15/2023 4:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/13/2022 1:53 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003272120A	9/13/2022 1:53 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	9/13/2022 1:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/13/2022 1:53 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		7Z1204	9/13/2022 1:53 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	9/13/2022 1:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/13/2022 1:53 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		7Z1203	9/13/2022 1:53 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	9/13/2022 1:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/26/2022 12:07 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		003272835B	8/26/2022 12:07 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	8/26/2022 12:07 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558028308	8/26/2022 12:07 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	8/26/2022 12:07 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558028308	8/26/2022 12:07 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	8/26/2022 12:07 PM
Details	Last Recertification Date	Update	Recertification	8/25/2021 8:57:50 AM	8/26/2022 12:07:03 PM	8/26/2022 12:07 PM
Contacts	Authorizing Official	Update	Change Request	Butcher, Allen R CFO AU Medical Center, Inc. 7067213929	Miller, Jennifer Chief Strategy Officer AU Medical Center, Inc. 7068367051	4/12/2022 1:28 PM
Details	Last Recertification Date	Update	Recertification	9/11/2020 1:49:41 PM	8/25/2021 8:57:50 AM	8/25/2021 8:57 AM
Contacts	Primary Contact	Update	Change Request	Tate, Keva 340B Program Manager AU Medical Center, Inc. 7067210082	Schick, Gerard Kristopher Business Operations Manager AU Medical Center, Inc 7067213979	4/8/2021 11:23 AM
Contacts	Authorizing Official	Update	Profile Change Request	Butcher, Allen R CFO AU Health 7067213929	Butcher, Allen R CFO AU Medical Center, Inc. 7067213929	4/8/2021 10:57 AM
Contacts	Authorizing Official	Update	AO Change Request	Gaillard, Timothy M. Chief Operating Officer AU Medical Center, Inc. 7067217228	Butcher, Allen R CFO AU Health 7067213929	4/8/2021 10:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/8/2021 3:28 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003242979A	1/8/2021 3:28 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	1/8/2021 3:28 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1699308114 (GA)		1/8/2021 3:28 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1699308114 (SC)		1/8/2021 3:28 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1033716915	1/8/2021 3:28 PM
Medicaid Billing	NPI: State	Insert	Change Request		GA	1/8/2021 3:28 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1033716915	1/8/2021 3:28 PM
Medicaid Billing	NPI: State	Insert	Change Request		SC	1/8/2021 3:28 PM
Addresses	Shipping Address	Delete	Change Request	MCG Health Inc 1120 15th Street Augusta, GA 30912		10/8/2020 9:43 AM
Addresses	Shipping Address	Insert	Change Request		AU Medical Center, Inc. 1120 15th Street Augusta, GA 30912	10/8/2020 9:43 AM
Addresses	Billing Address	Update	Change Request	MCG Health Inc 1120 15th Street Augusta, GA 30912	AU Medical Center, Inc. 1120 15th Street Augusta, GA 30912	10/8/2020 9:43 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1699308114	10/8/2020 9:43 AM
Medicaid Billing	NPI: State	Insert	Change Request		GA	10/8/2020 9:43 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1699308114	10/8/2020 9:43 AM
Medicaid Billing	NPI: State	Insert	Change Request		SC	10/8/2020 9:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 1:49 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000000723A	9/11/2020 1:49 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/11/2020 1:49 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	00000723A (GA)		9/11/2020 1:49 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1760886808 ( )		9/11/2020 1:49 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1487901476 ( )		9/11/2020 1:49 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1437135902 ( )		9/11/2020 1:49 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437135902	9/11/2020 1:49 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/11/2020 1:49 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1487901476	9/11/2020 1:49 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/11/2020 1:49 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760886808	9/11/2020 1:49 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/11/2020 1:49 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437135902	9/11/2020 1:49 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/11/2020 1:49 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1487901476	9/11/2020 1:49 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/11/2020 1:49 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1760886808	9/11/2020 1:49 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/11/2020 1:49 PM
Details	Last Recertification Date	Update	Recertification	8/23/2019 9:25:06 AM	9/11/2020 1:49:41 PM	9/11/2020 1:49 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	2/3/2020 12:27 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		7G0130	2/3/2020 12:27 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	2/3/2020 12:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	2/3/2020 12:27 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003160189A	2/3/2020 12:27 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	2/3/2020 12:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	2/3/2020 12:27 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003159433A	2/3/2020 12:27 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	2/3/2020 12:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	2/3/2020 12:27 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		358127	2/3/2020 12:27 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	2/3/2020 12:27 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1760886808	2/3/2020 12:27 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1487901476	2/3/2020 12:27 PM
Details	Last Recertification Date	Update	Recertification	8/20/2018 2:10:33 PM	8/23/2019 9:25:06 AM	8/23/2019 9:25 AM
Contacts	Authorizing Official	Update	AO Change Request	Liska, Lee Ann Chief Executive Officer AU Medical Center, Inc. 7067216569	Gaillard, Timothy M. Chief Operating Officer AU Medical Center, Inc. 7067217228	7/2/2019 3:08 PM
Details	Last Recertification Date	Update	Recertification	11/9/2017 3:36:47 PM	8/20/2018 2:10:33 PM	8/20/2018 2:10 PM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	11/9/2017 3:36:47 PM	11/9/2017 3:36 PM
Contacts	Authorizing Official	Update		Liska, Lee Ann Chief Executive Officer 7067216569	Liska, Lee Ann Chief Executive Officer AU Medical Center, Inc. 7067216569	10/2/2017 3:56 PM
Contacts	Primary Contact	Update		Tate, Keva 340B Program Manager 7067210082	Tate, Keva 340B Program Manager AU Medical Center, Inc. 7067210082	9/19/2017 2:47 PM
Contacts	Authorizing Official	Insert			Liska, Lee Ann Chief Executive Officer 7067216569	8/10/2017 11:52 AM
Contacts	Primary Contact	Update		Gomez, Tad A. Vice President for Professional Services 7067210797	Tate, Keva 340B Program Manager 7067210082	7/3/2017 2:58 PM
Contacts	Signed By	Insert			Buckley, Peter CEO 7067216569	3/14/2017 1:23 PM
Addresses	Main Address	Insert			821 St. Sebastian Way Augusta, GA 30912	3/14/2017 1:22 PM
Addresses	Billing Address	Insert			MCG Health Inc 1120 15th Street Augusta, GA 30912	3/14/2017 1:22 PM
Addresses	Shipping Address	Insert			MCG Health Inc 1120 15th Street Augusta, GA 30912	3/14/2017 1:22 PM
Details	Entity Name	Update		MCG MEDICAL CENTER	AU Medical Center, Inc.	3/14/2017 1:22 PM
Contacts	Primary Contact	Insert			Gomez, Tad A. Vice President for Professional Services 7067210797	8/10/2016 12:24 PM
Details	Last Recertification Date	Update		8/10/2015 12:00:00 AM	8/10/2016 12:00:00 AM	8/10/2016 12:24 PM
Details	Last Recertification Date	Update			8/10/2015 12:00:00 AM	8/10/2015 11:19 AM
Dates	Participating Approval Date	Update			3/4/2015 12:00:00 AM	3/4/2015 5:31 PM
Details	State	Update		Pending	Active	3/4/2015 5:31 PM
Dates	Start Date	Update			4/1/2015 12:00:00 AM	3/4/2015 5:31 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_48495	DSH110034E	1/9/2015 11:53 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_48495	1/9/2015 10:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/9/2015 10:42 AM
Medicaid Billing	Medicaid: Number	Insert			00000723A	1/9/2015 10:42 AM
Medicaid Billing	Medicaid: State	Insert			GA	1/9/2015 10:42 AM
Medicaid Billing	NPI: Number	Insert			1437135902	1/9/2015 10:42 AM
Details	Last Recertification Date	Insert				1/9/2015 10:42 AM
Details	Grant Number	Insert				1/9/2015 10:42 AM
Details	340B ID	Insert				1/9/2015 10:42 AM
Details	Is Authorizing Official EHB Data	Insert				1/9/2015 10:42 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/9/2015 10:42 AM
Details	Medicare Provider Number	Insert			110034	1/9/2015 10:42 AM
Details	Entity Name	Insert			MCG MEDICAL CENTER	1/9/2015 10:42 AM
Details	Program Code	Insert			DSH	1/9/2015 10:42 AM
Details	Entity Subname	Insert			Georgia Radiation Therapy Center	1/9/2015 10:42 AM
Dates	Participating Approval Date	Insert				1/9/2015 10:42 AM
Details	State	Insert			Pending	1/9/2015 10:42 AM
Dates	Registration Date	Insert			1/9/2015 12:00:00 AM	1/9/2015 10:42 AM
Dates	Signed By Date	Insert			1/9/2015 12:00:00 AM	1/9/2015 10:42 AM
Dates	Start Date	Insert				1/9/2015 10:42 AM
Terminations	Termination Comments	Insert				1/9/2015 10:42 AM
Terminations	Termination Date	Insert				1/9/2015 10:42 AM
Terminations	Termination Effective Date	Insert				1/9/2015 10:42 AM
Terminations	Termination Reason	Insert				1/9/2015 10:42 AM