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DSH110225A Piedmont Mountainside Hospital (Terminated)
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Main Details
Name
Piedmont Mountainside Hospital
Subdivision Name
Infusion Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110225A
Medicare Provider Number
110225
Outpatient Facility Provider Number
110225
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2014
Participating Start Date
4/1/2014
Participating Approval Date
3/11/2014
Last Recertification Date
8/21/2014
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Piedmont Healthcare Multiple Hospital Entities
John G. Miles, Vice President / CFO
(770) 400-2336
Primary Contact
Piedmont Mountainside Hospital
pam Mingo, Director of Pharmacy
(706) 301-5262 Ext: 5262
Addresses
Street Address
620 JL White Dr Suite 140
Jasper, GA 30143
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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