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DSH110078AW EMORY UNIVERSITY HOSPITAL MIDTOWN (Active)
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Main Details
Name
EMORY UNIVERSITY HOSPITAL MIDTOWN
Subdivision Name
PHARMACOTHERAPY CLINIC AT CLIFTON - PHARMACOTHERAPY CLINIC AT CLIFTON
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110078AW
Medicare Provider Number
110078
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/10/2024
Participating Start Date
4/1/2024
Participating Approval Date
1/18/2024
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
Emory Healthcare
Ava E Daunt-Samford, CFO
(404) 686-4918
Primary Contact
Emory Healthcare
Sydney Kchao, Corporate Director of Pharmacy, Business Operations and Finance
(404) 686-2147
Addresses
Street Address
1365A CLIFTON RD NE
RM A2000
ATLANTA, GA 30322-1013
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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