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DSH110089A COFFEE REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
COFFEE REGIONAL MEDICAL CENTER
Subdivision Name
Coffee Regional First Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH110089A
Medicare Provider Number
110089
Outpatient Facility Provider Number
113460
Additional Details
Current Program Status
Active
Registration Date
10/10/2016
Participating Start Date
1/1/2017
Participating Approval Date
11/15/2016
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Coffee Regional Medical Center
Lavonda Cravey, VP Corporate Revenue
(912) 383-5600
Primary Contact
Coffee Regional Medical Center
Peggy Kirkland, Director of Pharmacy
(912) 383-5609
Addresses
Street Address
1301 Peterson Avenue S
Suite B
Douglas, GA 31533
Billing Address
PO Box 1227 Douglas, GA 31534
Coffee Regional Medical Center
1101 Ocilla Road
Douglas, GA 31533
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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