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DSH110078V EMORY UNIVERSITY HOSPITAL MIDTOWN (Active)
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Main Details
Name
EMORY UNIVERSITY HOSPITAL MIDTOWN
Subdivision Name
Emory Imaging Stockbridge
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110078V
Medicare Provider Number
110078
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/9/2014
Participating Start Date
7/1/2014
Participating Approval Date
4/25/2014
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
Emory Healthcare
Ava E Daunt-Samford, CFO
(404) 686-4918
Primary Contact
Emory Healthcare
Sydney Kchao, Corporate Director of Pharmacy, Business Operations and Finance
(404) 686-2147
Addresses
Street Address
3625 GA Hwy 138
Stores 48
Stockbridge, GA 30281
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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