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SCH110124-00 Wayne Memorial Hospital (Terminated)
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Main Details
Name
Wayne Memorial Hospital
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH110124-00
Medicare Provider Number
110124
Additional Details
Current Program Status
Terminated
Registration Date
11/2/2011
Participating Start Date
1/1/2012
Participating Approval Date
12/19/2011
Last Recertification Date
8/19/2019
Termination Date
Termination Reason
7/1/2020
Change of hospital entity type
Contacts
Authorizing Official
Wayne Memorial Hospital
Gregory A. Jones, CFO
(912) 530-3305
Primary Contact
Wayne Memorial Hospital
Beth Hendrix Gorse, Director of Pharmacy
(912) 530-3365
Addresses
Street Address
865 South First Street
Jesup, GA 31545
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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