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DSH110095M TIFT REGIONAL HEALTH SYSTEM, INC (Approved)
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Main Details
Name
TIFT REGIONAL HEALTH SYSTEM, INC
Subdivision Name
Internal Medicine at Southwell Medical Clinic - Internal Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH110095M
Medicare Provider Number
110095
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/9/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/14/2025
Last Recertification Date
Contacts
Authorizing Official
Tift Regional Health System
Troy Buren Brooks, SVP/CFO
(229) 353-3397
Primary Contact
Tift Regional Health System, Inc.
Robert Evan Nix, Director of Pharmacy
(229) 353-6298
Addresses
Street Address
2225 Highway 41 North
Tifton, GA 31794
Billing Address
Tift Regional Medical Center
PO Box 747
Tifton, GA 31793
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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