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DSH110028 UNIVERSITY HOSPITAL (Terminated)
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Main Details
Name
UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110028
Medicare Provider Number
110028
Additional Details
Current Program Status
Terminated
Registration Date
4/10/2008
Participating Start Date
7/1/2002
Participating Approval Date
4/10/2008
Last Recertification Date
8/29/2018
Termination Date
Termination Reason
7/1/2019
DSH percentage below statutory minimum
Contacts
Authorizing Official
University Health, Inc.
James R. Davis, President and CEO
(706) 774-8061 Ext: 7064966908
Primary Contact
University Hospital
Marie Jackson, Director of Pharmacy
(706) 774-2718
Addresses
Street Address
1350 WALTON WAY
AUGUSTA, GA 30901
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/19/2010- DOC. RECD. TO CONFIRM DSH ADJ. %.
03/19/2010
May 2025
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