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DSH110034K AU Medical Center, Inc. (Terminated)
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Main Details
Name
AU Medical Center, Inc.
Subdivision Name
GEORGIA CANCER CENTER -AIKEN - Oncology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110034K
Medicare Provider Number
110034
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/8/2019
Participating Start Date
1/1/2020
Participating Approval Date
11/24/2019
Last Recertification Date
Termination Date
Termination Reason
10/1/2020
Site closure
Contacts
Authorizing Official
AU Medical Center, Inc.
Timothy M. Gaillard, Chief Operating Officer
(706) 721-7228
Primary Contact
AU Medical Center, Inc.
Keva Tate, 340B Program Manager
(706) 721-0082
Addresses
Street Address
1348 WALTON WAY
STE 6300C
AUGUSTA, GA 30901
Billing Address
AU Medical Center, Inc.
1120 15th Street
Augusta, GA 30912
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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