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DSH110015 TANNER MEDICAL CENTER/VILLA RICA (Active)
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Main Details
Name
TANNER MEDICAL CENTER/VILLA RICA
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110015
Medicare Provider Number
110015
Additional Details
Current Program Status
Active
Registration Date
4/11/2008
Participating Start Date
7/1/2005
Participating Approval Date
4/11/2008
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
Tanner Health System
Carol S. Crews, CFO
(770) 812-9745
Primary Contact
Tanner Health System
Emily Renee Allen, 340B Program Manager
(770) 812-8371
Addresses
Street Address
601 DALLAS ROAD
VILLA RICA, GA 30180
Billing Address
TANNER MEDICAL CENTER, Inc.
ATTN: ACCOUNTS PAYABLE
100 Greenway Blvd
Suite A
CARROLLTON, GA 30117
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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5/27/09 DOC RECD TO CONFIRM ELIG DSH ADJ%; 3/6/07 ADDR CHANGE (WAS 707 DALLAS HIGHWAY), REMOVED PO BOX
06/15/2009
June 2025
June 2025
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