340B Drug Pricing Program Database
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DSH110122M SOUTH GEORGIA MEDICAL CENTER (Active)
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Main Details
Name
SOUTH GEORGIA MEDICAL CENTER
Subdivision Name
SGMC SMITH NORTHVIEW - SNH Endoscopy
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110122M
Medicare Provider Number
110122
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/13/2023
Participating Start Date
10/1/2023
Participating Approval Date
7/20/2023
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
SGMC
Ronald E Dean, CEO
(229) 259-4102
Primary Contact
SGMC
Scott Bruce Smith, Director of Pharmacy
(229) 259-4870
Addresses
Street Address
4280 N VALDOSTA RD
VALDOSTA, GA 31602-6814
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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