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DSH110078AB EMORY UNIVERSITY HOSPITAL MIDTOWN (Terminated)
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Main Details
Name
EMORY UNIVERSITY HOSPITAL MIDTOWN
Subdivision Name
Internal Medicine at Emory Nephrology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110078AB
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
9/2/2016
Termination Date
Termination Reason
1/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
Emory
Greg E. Anderson, CFO
(404) 686-2823
Primary Contact
Emory Healthcare Inc
Christy Norman, VP Pharmacy Services
(404) 686-2304
Addresses
Street Address
1365-A Clifton Road NE
Building A- 4th floor
Atlanta, GA 30322
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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