340B Drug Pricing Program Database
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DSH110143A COBB HOSPITAL, INC. (Active)
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Main Details
Name
COBB HOSPITAL, INC.
Subdivision Name
WELLSTAR CHEMO INFUSION OF AUSTELL
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110143A
Medicare Provider Number
110143
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/12/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/23/2016
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Wellstar Cobb Hospital
Felix Soto Izaguirre, Chief Financial Officer
(470) 732-5039
Primary Contact
Wellstar Health System
Sarah Oliver, 340B Program Director
(470) 956-4931
Addresses
Street Address
1700 HOSPITAL SOUTH DRIVE
SUITE 302
AUSTELL, GA 30106-8116
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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