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CAH111335-00 LIBERTY REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
LIBERTY REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH111335-00
Medicare Provider Number
111335
Additional Details
Current Program Status
Active
Registration Date
9/23/2010
Participating Start Date
1/1/2011
Participating Approval Date
10/26/2010
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Liberty Regional Medical Center
Donna Cochrane, CNO
(912) 369-9441
Primary Contact
Liberty Regional Medical Center
Miranda Burgman, Director of Pharmacy
(912) 369-9482
Addresses
Street Address
462 E.G. MILES PARKWAY
HINESVILLE, GA 31313
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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