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DSH110007Y PHOEBE PUTNEY MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
PHOEBE PUTNEY MEMORIAL HOSPITAL
Subdivision Name
Phoebe North / Endoscopy
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH110007Y
Medicare Provider Number
110007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/7/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/15/2015
Last Recertification Date
11/13/2017
Termination Date
Termination Reason
10/1/2018
Site closure
Contacts
Authorizing Official
Phoebe Putney Memorial Hospital
Brian Church, CFO & CAO
(229) 312-4066
Primary Contact
Phoebe Putney Memorial Hospital
Randy Carver, MANAGER, PHARMACY
(229) 312-0115
Addresses
Street Address
2000 PALMYRA RD
ALBANY, GA 31701-1528
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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