340B Drug Pricing Program Database
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DSH110007AU PHOEBE PUTNEY MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
PHOEBE PUTNEY MEMORIAL HOSPITAL
Subdivision Name
DOUGHERTY COUNTY JAIL CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH110007AU
Medicare Provider Number
110007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2020
Participating Start Date
4/1/2020
Participating Approval Date
2/25/2020
Last Recertification Date
8/29/2023
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
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
1302 EVELYN AVENUE
ALBANY, GA 31705-1469
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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