340B Drug Pricing Program Database
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DSH110122C SOUTH GEORGIA MEDICAL CENTER (Active)
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Main Details
Name
SOUTH GEORGIA MEDICAL CENTER
Subdivision Name
Imaging Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110122C
Medicare Provider Number
110122
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/30/2024
Participating Start Date
11/12/2024
Participating Approval Date
11/13/2024
Last Recertification Date
Contacts
Authorizing Official
SGMC
Ronald E Dean, CEO
(229) 259-4102
Primary Contact
SGMC
Scott Bruce Smith, Director of Pharmacy
(229) 259-4870
Addresses
Street Address
2409 North Patterson Street
Valdosta, GA 31602
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating starting 1/1/2014; Terminated 10/1/2021; Reinstated 1/1/2025.
11/12/2024
May 2025
May 2025
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