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DSH110074A ATHENS REGIONAL MEDICAL CENTER, INC (Terminated)
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Main Details
Name
ATHENS REGIONAL MEDICAL CENTER, INC
Subdivision Name
Home Infusion
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110074A
Medicare Provider Number
110074
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/29/2011
Participating Start Date
10/1/2011
Participating Approval Date
9/29/2011
Last Recertification Date
8/26/2015
Termination Date
Termination Reason
7/1/2016
Loss of qualifying grant/support
Contacts
Authorizing Official
Piedmont Athens Regional Medical Center
Jason Grady Smith, COO
(706) 475-1860
Primary Contact
Don Wesley Tyson Jr., Director of Pharmacy
(706) 475-4438
Addresses
Street Address
1510 PRINCE AVENUE
ATHENS, GA 30606
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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