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DSH110109 EMANUEL MEDICAL CENTER (Terminated)
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Main Details
Name
EMANUEL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH110109
Medicare Provider Number
110109
Additional Details
Current Program Status
Terminated
Registration Date
6/4/2008
Participating Start Date
10/1/2004
Participating Approval Date
6/4/2008
Last Recertification Date
9/7/2021
Termination Date
Termination Reason
12/14/2021
Change of hospital entity type
Contacts
Authorizing Official
Emanuel Medical Center
Damien Scott, CEO
(478) 289-1306
Primary Contact
Emanuel Medical Center
Bailey Creamer, Director of Pharmacy
(478) 289-1302
Addresses
Street Address
117 KITE ROAD
SWAINSBORO, GA 30401
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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