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DSH110015A TANNER MEDICAL CENTER/VILLA RICA (Active)
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Main Details
Name
TANNER MEDICAL CENTER/VILLA RICA
Subdivision Name
TANNER HEALTH MS INFUSION CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110015A
Medicare Provider Number
110015
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
2/28/2011
Participating Start Date
12/13/2011
Participating Approval Date
3/15/2011
Last Recertification Date
8/29/2024
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
3200 DOWNWOOD CIRCLE NW
SUITE 550
ATLANTA, GA 30327
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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12/13/11 REINSTATED UNDER 2011 SPECIAL EXCEPTION POLICY FOR HOSPITALS, PARTICIPATING 4/1/11-4/19/11, NOT PARTICIPATING 4/20/11-12/12/11, ADDED BILL TO, NEW REGISTRATION WAS ELECTRONICALLY SIGNED BY Lee C. Sherseth ON 11/23/2011 AND INFORMATION FROM IT USED TO UPDATE THIS EXISTING RECORD
12/13/2011
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