340B Drug Pricing Program Database
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DSH110087DA Northside Hospital Gwinnett (Terminated)
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Main Details
Name
Northside Hospital Gwinnett
Subdivision Name
Northside Hospital Infusion Center Gwinnett - Infusion Services
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110087DA
Medicare Provider Number
110087
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2021
Participating Start Date
1/1/2022
Participating Approval Date
10/13/2021
Last Recertification Date
8/14/2023
Termination Date
Termination Reason
4/1/2024
DSH percentage below statutory minimum
Contacts
Authorizing Official
Northside Hospital, Inc.
Scott Wade, VP Finance
(404) 303-3381
Primary Contact
Northside Hospital Gwinnett
Michael James Naughton, Director of Pharmacy
(678) 312-4541
Addresses
Street Address
575 Professional Drive
Suite 510
Lawrenceville, GA 30046
Billing Address
Northside Hospital Gwinnett
1000 MEDICAL CENTER BLVD
LAWRENCEVILLE, GA 30046
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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