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DSH110078E EMORY UNIVERSITY HOSPITAL MIDTOWN (Active)
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Main Details
Name
EMORY UNIVERSITY HOSPITAL MIDTOWN
Subdivision Name
Non-Oncology Infusion Center at Clifton Campus (B1)
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110078E
Medicare Provider Number
110078
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
3/1/2012
Participating Start Date
4/1/2012
Participating Approval Date
3/29/2012
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
Emory Healthcare
Ava E Daunt-Samford, CFO
(404) 686-4918
Primary Contact
Emory Healthcare
Sydney Kchao, Corporate Director of Pharmacy, Business Operations and Finance
(404) 686-2147
Addresses
Street Address
1365B Clifton Road NE, Bldg B
B1234
Atlanta, GA 30322
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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