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DSH010164C COOSA VALLEY MEDICAL CENTER (Active)
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Main Details
Name
COOSA VALLEY MEDICAL CENTER
Subdivision Name
SYLACAUGA HEALTH CARE AUTH - Nix Family Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH010164C
Medicare Provider Number
010164
Outpatient Facility Provider Number
018503
Additional Details
Current Program Status
Active
Registration Date
1/9/2025
Participating Start Date
4/1/2025
Participating Approval Date
1/17/2025
Last Recertification Date
Contacts
Authorizing Official
Coosa Valley Medical Center
Brad McCormick, CFO
(256) 401-4534
Primary Contact
Coosa Valley Medical Center
Roger Morris, Director of Pharmacy
(256) 401-4066
Addresses
Street Address
33733 US HIGHWAY 280
CHILDERSBURG, AL 35044-3017
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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