340B Drug Pricing Program Database
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DSH110143G WELLSTAR COBB HOSPITAL (Terminated)
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Main Details
Name
WELLSTAR COBB HOSPITAL
Subdivision Name
WellStar Cobb Outpatient / Wellness Counseling Services
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110143G
Medicare Provider Number
110143
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/4/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/24/2017
Last Recertification Date
8/25/2021
Termination Date
Termination Reason
10/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Wellstar Cobb Hospital
Heath Austin King, CFO
(470) 732-5039
Primary Contact
WellStar Health System
Snehal Doshi, SVP Ancillary and Support Svcs
(470) 644-0322
Addresses
Street Address
1625 HOSPITAL NORTH DRIVE
SUITE 150
AUSTELL, GA 30106-8111
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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