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DSH110087Q GWINNETT HOSPITAL SYSTEM, INC (Terminated)
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Main Details
Name
GWINNETT HOSPITAL SYSTEM, INC
Subdivision Name
Gwinnett Cardiac Imaging/Nuclear Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110087Q
Medicare Provider Number
110087
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/13/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/4/2014
Last Recertification Date
8/26/2016
Termination Date
Termination Reason
1/1/2018
Site closure
Contacts
Authorizing Official
Northside Hospital, Inc.
Scott Wade, VP Finance
(404) 303-3381
Primary Contact
Gwinnett Hospital System, Inc
Michael James Naughton, Director of Pharmacy
(678) 312-4541
Addresses
Street Address
755 Walther Rd
Ste 130
Lawrenceville, GA 30046-8725
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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