340B Drug Pricing Program Database
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DSH110115G WellStar ATLANTA MEDICAL CENTER (Terminated)
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Main Details
Name
WellStar ATLANTA MEDICAL CENTER
Subdivision Name
Imaging Center Camp Creek
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110115G
Medicare Provider Number
110115
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2017
Participating Start Date
4/1/2017
Participating Approval Date
3/10/2017
Last Recertification Date
8/21/2018
Termination Date
Termination Reason
10/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
WellStar Atlanta Medical Center
Stuart D Downs, VP / Chief Operating Officer
(404) 265-4184
Primary Contact
WELLSTAR ATLANTA MEDICAL CENTER
Tonya Gifford, Pharmacy Director
(404) 466-8219
Addresses
Street Address
3890 Redwine Road
Suite 104
Atlanta, GA 30331
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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