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DSH110095B TIFT REGIONAL HEALTH SYSTEM, INC (Active)
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Main Details
Name
TIFT REGIONAL HEALTH SYSTEM, INC
Subdivision Name
DBA Tift Regional Medical Center - Outpatient Dialysis Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH110095B
Medicare Provider Number
110095
Outpatient Facility Provider Number
110095
Additional Details
Current Program Status
Active
Registration Date
7/10/2014
Participating Start Date
10/1/2014
Participating Approval Date
8/29/2014
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Tift Regional Health System
Troy Buren Brooks, SVP/CFO
(229) 353-3397
Primary Contact
Tift Regional Health System, Inc.
Robert Evan Nix, Director of Pharmacy
(229) 353-6298
Addresses
Street Address
1010 Edgefield Drive
Tifton, GA 31794
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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