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DSH110089 COFFEE REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
COFFEE REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH110089
Medicare Provider Number
110089
Additional Details
Current Program Status
Active
Registration Date
3/2/2007
Participating Start Date
4/1/2007
Participating Approval Date
3/2/2007
Last Recertification Date
9/8/2024
Contacts
Authorizing Official
Coffee Regional Medical Center
Lavonda Cravey, VP Corporate Revenue
(912) 383-5600
Primary Contact
Coffee Regional Medical Center
Peggy Kirkland, Director of Pharmacy
(912) 383-5609
Addresses
Street Address
1101 OCILLA ROAD
DOUGLAS, GA 31533
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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1/18/12 change zipcode from 31534 to 31533
01/18/2012
April 2025
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