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DSH110143P COBB HOSPITAL, INC. (Active)
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Main Details
Name
COBB HOSPITAL, INC.
Subdivision Name
WELLSTAR COBB HOSPITAL HEART FAILUR - Wellstar Cobb Heart Failure Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110143P
Medicare Provider Number
110143
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/14/2021
Participating Start Date
4/1/2021
Participating Approval Date
1/27/2021
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
1791 MULKEY RD
STE 101
AUSTELL, GA 30106-1124
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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