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DSH110007AN PHOEBE PUTNEY MEMORIAL HOSPITAL (Active)
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Main Details
Name
PHOEBE PUTNEY MEMORIAL HOSPITAL
Subdivision Name
PHOEBE CARDIAC NUCLEAR MEDICINE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH110007AN
Medicare Provider Number
110007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2019
Participating Start Date
1/1/2020
Participating Approval Date
11/1/2019
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
Phoebe Putney Memorial Hospital
Brian Church, CFO & CAO
(229) 312-4066
Primary Contact
Phoebe Putney Health Systems
Torey Alaine Jones, 340B Program Pharmacy Manager
(229) 312-2177
Addresses
Street Address
425 W THIRD AVENUE
STE 650
ALBANY, GA 31701-1941
Billing Address
Phoebe Putney Memorial Hospital
417 W Third Avenue
Albany, GA 31701-1943
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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