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DSH110089B COFFEE REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
COFFEE REGIONAL MEDICAL CENTER
Subdivision Name
CRMC Outpatient Infusion Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH110089B
Medicare Provider Number
110089
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/17/2017
Participating Start Date
10/1/2017
Participating Approval Date
8/1/2017
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Coffee Regional Medical Center
Lavonda Cravey, VP Corporate Revenue
(912) 383-5600
Primary Contact
Coffee Regional Medical Center
Peggy Kirkland, Director of Pharmacy
(912) 383-5609
Addresses
Street Address
1101 Ocilla Rd
Douglas, GA 31533
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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