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DSH110073 DORMINY MEDICAL CENTER (Terminated)
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Main Details
Name
DORMINY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH110073
Medicare Provider Number
110073
Additional Details
Current Program Status
Terminated
Registration Date
9/8/2005
Participating Start Date
9/9/2005
Participating Approval Date
9/9/2005
Last Recertification Date
9/7/2023
Termination Date
Termination Reason
4/1/2024
DSH percentage below statutory minimum
Contacts
Authorizing Official
Dorminy Medical Center
PAIGE WYNN, CFO
(229) 424-7170
Primary Contact
Irwin County Hospital
Brett Crumbley, Director of Pharmacy
(229) 424-7235
Addresses
Street Address
200 PERRY HOUSE ROAD
FITZGERALD, GA 31750
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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