340B Drug Pricing Program Database
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DSH110044B PHOEBE SUMTER MEDICAL CENTER (Active)
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Main Details
Name
PHOEBE SUMTER MEDICAL CENTER
Subdivision Name
Ellaville Rural Health Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH110044B
Medicare Provider Number
110044
Outpatient Facility Provider Number
113403
Additional Details
Current Program Status
Active
Registration Date
4/8/2019
Participating Start Date
7/1/2019
Participating Approval Date
4/12/2019
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
Phoebe Sumter Medical Center, Inc
Michelle H Doggett, VP Controller, PSMC
(229) 931-1288
Primary Contact
Phoebe Sumter Medical Center, Inc.
Darryl Lane Hawkins, Manager, Pharmacy
(229) 931-1209
Addresses
Street Address
339 S BROAD STREET
ELLAVILLE, GA 31806-3304
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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