340B Drug Pricing Program Database
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DSH110087CW Northside Hospital Gwinnett (Terminated)
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Main Details
Name
Northside Hospital Gwinnett
Subdivision Name
CENTER FOR CANCER CARE HAMILTONMILL - Infusion Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110087CW
Medicare Provider Number
110087
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/9/2019
Participating Start Date
4/1/2019
Participating Approval Date
1/16/2019
Last Recertification Date
8/14/2023
Termination Date
Termination Reason
10/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
Northside Hospital, Inc.
Scott Wade, VP Finance
(404) 303-3381
Primary Contact
Northside Hospital Gwinnett
Michael James Naughton, Director of Pharmacy
(678) 312-4541
Addresses
Street Address
2098 TERON TRCE
STE 400&500
DACULA, GA 30019-1663
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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