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DSH110132 MEMORIAL HOSPITAL AND MANOR (Active)
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Main Details
Name
MEMORIAL HOSPITAL AND MANOR
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH110132
Medicare Provider Number
110132
Additional Details
Current Program Status
Active
Registration Date
4/30/2008
Participating Start Date
10/1/2004
Participating Approval Date
4/30/2008
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
Memorial Hospital & Manor
Stephen Gambrell, VP, Clinical/Support Services
(229) 246-3500
Primary Contact
Memorial Hospital and Manor
Allison Faith Howard-Denton, Director of Pharmacy
(229) 243-6163
Addresses
Street Address
1500 E SHOTWELL STREET
BAINBRIDGE, GA 39819
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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