340B Drug Pricing Program Database

Name

AU Medical Center, Inc.

Subdivision Name

ASMP / Oncology Clinic

Type

Disproportionate Share Hospital

Rural

No

340B ID

DSH110034J

Medicare Provider Number

110034

Outpatient Facility Provider Number

Current Program Status

Terminated

Registration Date

1/4/2017

Participating Start Date

4/1/2017

Participating Approval Date

1/9/2017

Last Recertification Date

8/22/2018

Termination Date
Termination Reason

4/1/2019
Business decision by the Covered Entity

Authorizing Official

AU Medical Center, Inc.
Timothy M. Gaillard, Chief Operating Officer
(706) 721-7228

Primary Contact

AU Medical Center, Inc.
Keva Tate, 340B Program Manager
(706) 721-0082

Street Address

3001 Gordon Highway
A143
Grovetown, GA 30813

Billing Address

MCG Health Inc.
1120 15th Street
Augusta, GA 30912