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DSH250077D WAYNE GENERAL HOSPITAL (Active)
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Main Details
Name
WAYNE GENERAL HOSPITAL
Subdivision Name
WAYNE GENERAL HOSPITAL - Wayne General School Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250077D
Medicare Provider Number
250077
Outpatient Facility Provider Number
258652
Additional Details
Current Program Status
Active
Registration Date
8/30/2022
Participating Start Date
8/31/2022
Participating Approval Date
8/31/2022
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Wayne General Hospital
Andrew Porter, CEO
(601) 735-5151 Ext: 100
Primary Contact
Wayne General Hospital
Clinton Eaves, CFO
(601) 735-7103
Addresses
Street Address
1325 AZALEA DR
WAYNESBORO, MS 39367-2258
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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