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DSH110024L CANDLER HOSPITAL (Active)
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Main Details
Name
CANDLER HOSPITAL
Subdivision Name
SJ/C INFUSION SERVICES - PEMBROKE - Oncology Infusion
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110024L
Medicare Provider Number
110024
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/3/2023
Participating Start Date
1/9/2023
Participating Approval Date
1/4/2023
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Candler Hospital
PAUL P. HINCHEY, CEO
(912) 819-6901
Primary Contact
St. Joseph's/Candler
Tommy Harvey, Business Manager Pharmacy
(912) 819-8155
Addresses
Street Address
159 W RAILROAD ST
BUILDING B
PEMBROKE, GA 31321
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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