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DSH110130 IRWIN COUNTY HOSPITAL (Terminated)
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Main Details
Name
IRWIN COUNTY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110130
Medicare Provider Number
110130
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/26/2017
Last Recertification Date
8/31/2022
Termination Date
Termination Reason
10/1/2023
Loss of qualifying hospital status
Contacts
Authorizing Official
Dorminy Medical Center
Paige Wynn, COO / CFO
(229) 468-3845
Primary Contact
Irwin County Hospital
Brett Crumbley, Director of Pharmacy
(229) 424-7235
Addresses
Street Address
710 NORTH IRWIN AVENUE
OCILLA, GA 31774
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/26/17 Initial start date 4/1/2005, termination date 7/1/2012, reinstate 7/1/2017.
04/26/2017
May 2025
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