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DSH010164A COOSA VALLEY MEDICAL CENTER (Active)
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Main Details
Name
COOSA VALLEY MEDICAL CENTER
Subdivision Name
Hematology/Oncology - Coosa Valley Hematology and Oncology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH010164A
Medicare Provider Number
010164
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/14/2020
Participating Start Date
7/1/2020
Participating Approval Date
4/15/2020
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Coosa Valley Medical Center
Brad McCormick, CFO
(256) 401-4534
Primary Contact
Coosa Valley Medical Center
Roger Morris, Director of Pharmacy
(256) 401-4066
Addresses
Street Address
209 W. Spring Street
Suite 303
Sylacauga, AL 35150
Billing Address
Coosa Valley Medical Center
315 W. Hickory Street
Sylacauga, AL 35150
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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