340B Drug Pricing Program Database
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DSH110087X Northside Hospital Gwinnett (Terminated)
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Main Details
Name
Northside Hospital Gwinnett
Subdivision Name
GWINNETT MEDICAL CENER - DULUTH / Short Stay Unit GMCD
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110087X
Medicare Provider Number
110087
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/17/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/27/2017
Last Recertification Date
8/20/2019
Termination Date
Termination Reason
10/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
Northside Hospital, Inc.
Scott Wade, VP Finance
(404) 303-3381
Primary Contact
Gwinnett Hospital System, Inc
Michael James Naughton, Director of Pharmacy
(678) 312-4541
Addresses
Street Address
3620 HOWELL FERRY RD
DULUTH, GA 30096-3178
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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