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DSH110107G MEDICAL CENTER OF CENTRAL GEORGIA (Terminated)
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Main Details
Name
MEDICAL CENTER OF CENTRAL GEORGIA
Subdivision Name
Baldwin County EMS (EMS Baldwin)
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110107G
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
8/24/2016
Termination Date
Termination Reason
1/1/2018
Site closure
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
560 W. Martin Luther King Jr Dr
Milledgeville, GA 31061
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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