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DSH110089C COFFEE REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
COFFEE REGIONAL MEDICAL CENTER
Subdivision Name
CRMC Wound Care Clinic - Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH110089C
Medicare Provider Number
110089
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/16/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/1/2018
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
305 Westside Drive
Douglas, GA 31533
Billing Address
Coffee Regional Medical Center Wound Care
P O Box 1287
Douglas, GA 31534
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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