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DSH110007BA PHOEBE PUTNEY MEMORIAL HOSPITAL (Approved)
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Main Details
Name
PHOEBE PUTNEY MEMORIAL HOSPITAL
Subdivision Name
Medication Management Clinic II - MMC II
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH110007BA
Medicare Provider Number
110007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/8/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/14/2025
Last Recertification Date
Contacts
Authorizing Official
Phoebe Putney Memorial Hospital
Brian Church, CFO & CAO
(229) 312-4066
Primary Contact
Phoebe Putney Health Systems
Torey Alaine Jones, 340B Program Pharmacy Manager
(229) 312-2177
Addresses
Street Address
2740 Ray Knight Way
Suite 200
Albany, GA 31707-0228
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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