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DSH110143M COBB HOSPITAL, INC. (Active)
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Main Details
Name
COBB HOSPITAL, INC.
Subdivision Name
NORTHWEST GEORGIA ONCOLOGY CENTERS - Northwest Georgia Oncology Paulding
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110143M
Medicare Provider Number
110143
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/9/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/9/2019
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Wellstar Cobb Hospital
Felix Soto Izaguirre, Chief Financial Officer
(470) 732-5039
Primary Contact
Wellstar Health System
Sarah Oliver, 340B Program Director
(470) 956-4931
Addresses
Street Address
144 BILL CARRUTH PKWY
STE 3100
HIRAM, GA 30141-3819
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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