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DSH110107D MEDICAL CENTER OF CENTRAL GEORGIA (Terminated)
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Main Details
Name
MEDICAL CENTER OF CENTRAL GEORGIA
Subdivision Name
Outpatient Rehab Services
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110107D
Medicare Provider Number
110107
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/7/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/17/2012
Last Recertification Date
11/20/2017
Termination Date
Termination Reason
4/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
The Medical Center Navicent Health
Susan Harris, COO
(478) 633-1452
Primary Contact
The Medical Center Navicent Health
Jennafer Hill Pennell, Interim Director of Pharmacy
(478) 633-1440
Addresses
Street Address
770 Hemlock Street
Macon, GA 31201
Billing Address
Medical Center of Central Georgia
777 Hemlock Street
MSC #113
Macon, GA 31201
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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