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DSH110007J PHOEBE PUTNEY MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
PHOEBE PUTNEY MEMORIAL HOSPITAL
Subdivision Name
Phoebe Cancer Center Sickle Cell Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH110007J
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
11/13/2017
Termination Date
Termination Reason
10/1/2018
Site closure
Contacts
Authorizing Official
Phoebe Putney Memorial Hospital
Brian Church, CFO & CAO
(229) 312-4066
Primary Contact
Phoebe Putney Memorial Hospital
Randy Carver, MANAGER, PHARMACY
(229) 312-0115
Addresses
Street Address
1009 North Monroe Street Suite B
Albany, GA 31701-1944
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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