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DSH110015C TANNER MEDICAL CENTER/VILLA RICA (Approved)
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Main Details
Name
TANNER MEDICAL CENTER/VILLA RICA
Subdivision Name
Northwest Georgia Oncology Centers - Carrollton - Oncology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110015C
Medicare Provider Number
110015
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/10/2025
Participating Start Date
7/1/2025
Participating Approval Date
5/8/2025
Last Recertification Date
Contacts
Authorizing Official
Tanner Health System
Carol S. Crews, CFO
(770) 812-9745
Primary Contact
Tanner Health System
Emily Renee Allen, 340B Program Manager
(770) 812-8371
Addresses
Street Address
157 Clinic Ave
Suite 202
Carrollton, GA 30117
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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