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DSH110007L PHOEBE PUTNEY MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
PHOEBE PUTNEY MEMORIAL HOSPITAL
Subdivision Name
PHOEBE REHABILITATION OF SYLVESTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH110007L
Medicare Provider Number
110007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/9/2012
Participating Start Date
1/1/2013
Participating Approval Date
11/27/2012
Last Recertification Date
8/30/2016
Termination Date
Termination Reason
1/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
Phoebe Putney Memorial Hospital
Brian Church, CFO & CAO
(229) 312-4066
Primary Contact
Phoebe Putney Memorial Hospital
Randy Carver, Pharmacy Manager
(229) 312-0115
Addresses
Street Address
1009 W. Franklin Street
Sylvester, GA 31791-7174
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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