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DSH110011 TANNER MEDICAL CENTER (Terminated)
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Main Details
Name
TANNER MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110011
Medicare Provider Number
110011
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2024
Participating Start Date
7/1/2024
Participating Approval Date
5/6/2024
Last Recertification Date
8/29/2024
Termination Date
Termination Reason
1/1/2025
DSH percentage below statutory minimum
Contacts
Authorizing Official
Tanner Health System
Carol S. Crews, CFO
(770) 812-9745
Primary Contact
Tanner Health System
Emily Miller, 340B Program Manager
(770) 812-8371
Addresses
Street Address
705 DIXIE STREET
CARROLLTON, GA 30117
Billing Address
Tanner Medical Center, Inc.
100 Greenway Blvd
Suite A
Carrollton, GA 30117
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date 4/1/2017, Termination Date 1/1/2018, Reinstatement 7/1/2024
05/06/2024
6/21/2010- DOC. RECD. TO CONFIRM ELIGIBILITY; ELIG.FROM 7/1/2005 TO 3/31/2007, INELIGIBLE FROM 4/1/2007 TO 6/30/2010.
06/22/2010
April 2025
April 2025
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