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DSH110225 PIEDMONT MOUNTAINSIDE HOSPITAL INC. (Terminated)
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Main Details
Name
PIEDMONT MOUNTAINSIDE HOSPITAL INC.
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110225
Medicare Provider Number
110225
Additional Details
Current Program Status
Terminated
Registration Date
9/14/2007
Participating Start Date
4/1/2014
Participating Approval Date
9/14/2007
Last Recertification Date
8/22/2018
Termination Date
Termination Reason
1/1/2019
DSH percentage below statutory minimum
Contacts
Authorizing Official
Piedmont Healthcare Multiple Hospital Entities
John G. Miles, Vice President / CFO
(770) 400-2336
Primary Contact
Piedmont Mountainside Hospital
pam Mingo, Director of Pharmacy
(706) 301-5262 Ext: 5262
Addresses
Street Address
1266 HIGHWAY 515 SOUTH
JASPER, GA 30143
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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9/17/14 - Corrected typo in period of ineligibility. 03/14/14- CE reinstated starting 04/01/14, was participating 10/01/07 to 03/31/2012, not participating 4/1/2012 to 03/31/2014 due to CE request;8/31/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %
09/17/2014
03/14/14- CE reinstated starting 04/01/14, was participating 10/01/07 to 03/31/2012, not participating 4/1/2013 to 03/31/2014 due to CE request;8/31/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %
03/14/2014
8/31/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %
10/19/2009
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