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DSH110078Y EMORY UNIVERSITY HOSPITAL MIDTOWN (Terminated)
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Main Details
Name
EMORY UNIVERSITY HOSPITAL MIDTOWN
Subdivision Name
EUHM Radiology (PET) - Medical Office Tower
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110078Y
Medicare Provider Number
110078
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2014
Participating Start Date
7/1/2014
Participating Approval Date
4/25/2014
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, 8th floor
Atlanta, GA 30308
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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