340B Drug Pricing Program Database
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DSH110087BE Northside Hospital Gwinnett (Terminated)
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Main Details
Name
Northside Hospital Gwinnett
Subdivision Name
CENTER FOR SCREENING MAMMOGRAPHY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110087BE
Medicare Provider Number
110087
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/27/2017
Last Recertification Date
9/9/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Northside Hospital, Inc.
Scott Wade, VP Finance
(404) 303-3381
Primary Contact
Northside Hospital Gwinnett
Michael James Naughton, Director of Pharmacy
(678) 312-4541
Addresses
Street Address
3855 PLEASANT HILL ROAD
SUITE 340
DULUTH, GA 30096-8030
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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