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CH04211T Georgia Mountains Health Services, Inc. (Terminated)
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Main Details
Name
Georgia Mountains Health Services, Inc.
Subdivision Name
Superfriendly Dental
Type
HRSA-Funded Health Center
Site ID
BPS-H80-021257
340B ID
CH04211T
Grant Number
H80CS00093
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/19/2018
Last Recertification Date
2/4/2023
Termination Date
Termination Reason
4/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Georgia Mountains Health Services, Inc
Steven Miracle, CEO
(706) 946-5610
Primary Contact
Georgia Mtns Health
Randy Westbrook, CFO
(706) 946-5609
Addresses
Street Address
160 Sailors Dr
Ellijay, GA 30540-3743
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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June 2025
June 2025
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