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DSH110078M EMORY UNIVERSITY HOSPITAL MIDTOWN (Terminated)
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Main Details
Name
EMORY UNIVERSITY HOSPITAL MIDTOWN
Subdivision Name
Emory Heart and Vascular Imaging at EUHM Campus
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110078M
Medicare Provider Number
110078
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/8/2014
Participating Start Date
7/1/2014
Participating Approval Date
6/11/2014
Last Recertification Date
9/8/2020
Termination Date
Termination Reason
10/1/2021
Other
Contacts
Authorizing Official
Emory
Greg E. Anderson, CFO
(404) 686-2823
Primary Contact
Emory Healthcare
Sydney Kchao, Corporate Director of Pharmacy, Business Operations and Finance
(404) 686-2147
Addresses
Street Address
550 Peachtree Street NE
Medical Office Tower, 6th Floor
Atlanta, GA 30308
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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