340B Drug Pricing Program Database
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DSH110087P Northside Hospital Gwinnett (Terminated)
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Main Details
Name
Northside Hospital Gwinnett
Subdivision Name
Wound Treatment Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110087P
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
8/25/2022
Termination Date
Termination Reason
7/1/2023
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
665 Duluth Hwy
Ste 600
Lawrenceville, GA 30046
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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