340B Drug Pricing Program Database
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DSH110087A Northside Hospital Gwinnett (Terminated)
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Main Details
Name
Northside Hospital Gwinnett
Subdivision Name
GWINNETT MEDICAL CENTER-DULUTH
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110087A
Medicare Provider Number
110087
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/4/2009
Participating Start Date
10/1/2009
Participating Approval Date
9/14/2009
Last Recertification Date
9/2/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Northside Hospital, Inc.
Scott Wade, VP Finance
(404) 303-3381
Primary Contact
Northside Hospital Gwinnett
Michael James Naughton, Director of Pharmacy
(678) 312-4541
Addresses
Street Address
3620 HOWELL FERRY ROAD
DULUTH, GA 30096
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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