340B Drug Pricing Program Database
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DSH110087G Northside Hospital Gwinnett (Terminated)
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Main Details
Name
Northside Hospital Gwinnett
Subdivision Name
Johns Creek Orthopedic Surgery Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110087G
Medicare Provider Number
110087
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2013
Participating Start Date
1/1/2014
Participating Approval Date
11/26/2013
Last Recertification Date
9/2/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Northside Hospital, Inc.
Scott Wade, VP Finance
(404) 303-3381
Primary Contact
Northside Hospital Gwinnett
Michael James Naughton, Director of Pharmacy
(678) 312-4541
Addresses
Street Address
10670 Medlock Bridge Road
Duluth, GA 30097-8441
Billing Address
Gwinnett Hospital System, Inc
PO Box 1190
Lawrenceville, GA 30046-1190
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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