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DSH110078 EMORY UNIVERSITY HOSPITAL MIDTOWN (Active)
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Main Details
Name
EMORY UNIVERSITY HOSPITAL MIDTOWN
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110078
Medicare Provider Number
110078
Additional Details
Current Program Status
Active
Registration Date
3/1/2006
Participating Start Date
4/1/2006
Participating Approval Date
3/1/2006
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
Emory Decatur, Emory Hillandale
Lisa Urbistondo, Vice President & CFO
(404) 501-5025
Primary Contact
Emory Healthcare
Sydney Kchao, Corporate Director of Pharmacy, Business Operations and Finance
(404) 686-2147
Addresses
Street Address
550 PEACHTREE STREET, NE
ATLANTA, GA 30308-2209
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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7/31/09 UPDATED ENTITY NAME (WAS EMORY CRAWFORD LONG HOSPITAL) 6/24/10 ADDED SHIP TO ADDRESS
06/24/2010
7/31/09 UPDATED ENTITY NAME (WAS EMORY CRAWFORD LONG HOSPITAL) 6/24/10 ADDED SHIP TO ADDRESS
03/01/2006
May 2025
May 2025
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