340B Drug Pricing Program Database
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DSH110087J Northside Hospital Gwinnett (Terminated)
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Main Details
Name
Northside Hospital Gwinnett
Subdivision Name
Gwinnett SportsRehab-Duluth
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110087J
Medicare Provider Number
110087
Outpatient Facility Provider Number
110087
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2014
Participating Start Date
7/1/2014
Participating Approval Date
5/9/2014
Last Recertification Date
9/2/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Northside Hospital, Inc.
Scott Wade, VP Finance
(404) 303-3381
Primary Contact
Northside Hospital Gwinnett
Michael James Naughton, Director of Pharmacy
(678) 312-4541
Addresses
Street Address
3215 MCCLURE BRIDGE RD
Duluth, GA 30096-3223
Billing Address
Gwinnett Hospital System, Inc
PO Box 1190
Lawrenceville, GA 30046-1190
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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