Covered Entity Details

DSH110229 Piedmont Newnan Hospital, Inc. (Terminated) - information as of 5/6/2025 11:02:38 PM

Main Details

Name

Piedmont Newnan Hospital, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH110229

Medicare Provider Number

110229

Additional Details

Current Program Status

Terminated

Registration Date

4/8/2013

Participating Start Date

7/1/2013

Participating Approval Date

5/13/2013

Last Recertification Date

9/3/2019

Termination Date
Termination Reason

1/1/2020
DSH percentage below statutory minimum

Contacts

Authorizing Official

Piedmont Healthcare Multiple Hospital Entities
John G. Miles, Vice President / CFO
(770) 400-2336

Primary Contact

Piedmont Newnan Hospital
David Copelan, Director of Pharmacy
(770) 400-2460

Addresses

Street Address

745 Poplar Road
Newnan, GA 30265

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
GA	000000492A
		1134133002

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	01/15/2018	04/01/2018	01/01/2020	01/01/2020
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	01/15/2018	04/01/2018	01/01/2020	01/01/2020
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	01/15/2018	04/01/2018	01/01/2020	01/01/2020
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	01/15/2018	04/01/2018	01/01/2020	01/01/2020
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	01/15/2018	04/01/2018	01/01/2020	01/01/2020
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	01/15/2018	04/01/2018	01/01/2020	01/01/2020
Contract Detail	BIOPLUS SPECIALTY PHARMACY LA, LLC	2731 MANHATTAN BLVD STE B17		HARVEY	LA	70058	07/11/2019	10/01/2019	01/01/2020	01/01/2020
Contract Detail	BIOPLUS SPECIALTY PHARMACY, INC	3200 LAKE EMMA RD UNIT 1000		LAKE MARY	FL	32746	07/11/2019	10/01/2019	01/01/2020	01/01/2020
Contract Detail	CYSTIC FIBROSIS SERVICES	CYSTIC FIBROSIS SERVICES, INC	10530 JOHN W ELLIOTT DR, STE 200	FRISCO	TX	75033	07/16/2015	10/01/2015	08/09/2017	02/01/2018
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/07/2017	07/01/2017	01/01/2020	01/01/2020
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	10/17/2017	01/01/2018	01/01/2020	01/01/2020
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	12/09/2017	01/01/2018	01/01/2018	11/06/2018
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	12/09/2017	01/01/2018	01/01/2020	01/01/2020
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/17/2017	01/01/2018	01/01/2020	01/01/2020
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	255 PHILLIPI ROAD	COLUMBUS	OH	43228	10/17/2017	01/01/2018	06/29/2018	07/13/2018
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	10/17/2017	01/01/2018	01/01/2020	01/01/2020
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00962	1035 LOWER FAYETTEVILLE RD.	NEWNAN	GA	30265	07/11/2017	10/01/2017	01/01/2020	01/01/2020
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02544	101 LEXINGTON CIRCLE	PEACHTREE CITY	GA	30269	07/11/2017	10/01/2017	01/01/2020	01/01/2020
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07214	2305 HWY 34 EAST	NEWNAN	GA	30265	07/11/2017	10/01/2017	01/01/2020	01/01/2020
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07216	239 TEMPLE AVENUE	NEWNAN	GA	30263	07/11/2017	10/01/2017	01/01/2020	01/01/2020
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 08907	395 JACKSON ST.	NEWNAN	GA	30263	07/11/2017	10/01/2017	01/01/2020	01/01/2020
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16578	555 BULLSBORO DR	NEWNAN	GA	30265	07/11/2017	10/01/2017	01/01/2020	01/01/2020
Contract Detail	KROGER DRUGSTORE #363	48 BULLSBORO DRIVE		NEWNAN	GA	30263	07/11/2019	10/01/2019	01/01/2020	01/01/2020
Contract Detail	KROGER DRUGSTORE #388	564 CROSSTOWN DRIVE		PEACHTREE CITY	GA	30269	07/11/2019	10/01/2019	01/01/2020	01/01/2020
Contract Detail	KROGER DRUGSTORE #420	3150 EAST HIGHWAY 34		NEWNAN	GA	30265	07/11/2019	10/01/2019	01/01/2020	01/01/2020
Contract Detail	KROGER DRUGSTORE #422	1101 PEACHTREE PARKWAY NORTH		PEACHTREE CITY	GA	30269	07/11/2019	10/01/2019	01/01/2020	01/01/2020
Contract Detail	KROGER DRUGSTORE #490	805 S. GLYNN STREET	SUITE 117	FAYETTEVILLE	GA	30215	07/11/2019	10/01/2019	01/01/2020	01/01/2020
Contract Detail	KROGER PHARMACY #647	1751 NEWNAN CROSSING BLVD. E.		NEWNAN	GA	30265	07/11/2019	10/01/2019	01/01/2020	01/01/2020
Contract Detail	KROGER SPECIALTY PHARMACY FL 2	6435 HAZELTINE NATIONAL DR STE 140		ORLANDO	FL	32822-5156	07/11/2019	10/01/2019	01/01/2020	01/01/2020
Contract Detail	OPTION CARE ENTERPRISES, INC.	D/B/A OPTION CARE	11403 BLUEGRASS PARKWAY SUITE 400	LOUISVILLE	KY	40299-2398	01/15/2018	04/01/2018	01/01/2020	01/01/2020
Contract Detail	OPTION CARE ENTERPRISES, INC.	OPTION CARE	5854 PEACHTREE CORNERS EAST SUITE 200	PEACHTREE CORNERS	GA	30092-3410	01/15/2018	04/01/2018	01/01/2020	01/01/2020
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/10/2017	10/01/2017	01/01/2020	01/01/2020
Contract Detail	PUBLIX PHARMACY #0470	370 BULLSBORO DRIVE		NEWNAN	GA	30263	04/10/2019	07/01/2019	01/01/2020	01/01/2020
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #786	100 GLENDA TRACE	NEWNAN	GA	30265	04/10/2019	07/01/2019	01/01/2020	01/01/2020
Contract Detail	PUBLIX SUPER MARKETS INC	PUBLIX PHARMACY #799	1200 HWY 74 S STE 20	PEACHTREE CITY	GA	30269	04/10/2019	07/01/2019	01/01/2020	01/01/2020
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX CENTRAL PHARMACY #3201	2424 ORLANDO CENTRAL PARKWAY	ORLANDO	FL	32809	04/10/2019	07/01/2019	01/01/2020	01/01/2020
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1143	1111 LOWER FAYETTEVILLE RD.	NEWNAN	GA	30265	04/10/2019	07/01/2019	01/01/2020	01/01/2020
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #3213	1950 SAND LAKE RD, BLDG #5	ORLANDO	FL	32809	04/10/2019	07/01/2019	01/01/2020	01/01/2020
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/12/2017	10/01/2017	05/23/2018	09/18/2018
Contract Detail	WAL-MART PHARMACY #10-0494	1025 HIGHWAY 34 E		NEWNAN	GA	30265-6803	07/12/2017	10/01/2017	05/23/2018	09/18/2018
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/12/2017	10/01/2017	05/23/2018	09/18/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS #02454	3116 HWY 34 EAST	NEWNAN	GA	30265	04/15/2014	07/01/2014	01/01/2020	01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09890	1 MILLARD FARMER INDUSTRIAL BLVD	NEWNAN	GA	30263-1078	04/15/2014	07/01/2014	01/01/2020	01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS #13641	35 COLLIER ROAD NW SUITE 100	ATLANTA	GA	30309	01/11/2018	04/01/2018	01/01/2020	01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS #17278	211 TEMPLE AVE	NEWNAN	GA	30263	07/13/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS #17952	1232 HIGHWAY 74 S	PEACHTREE CITY	GA	30269	07/13/2018	10/01/2018	01/01/2020	01/01/2020
Contract Detail	WALGREEN CO.	RITE AID #11779	101 CITY CIR	PEACHTREE CITY	GA	30269	07/13/2018	10/01/2018	09/27/2018	10/10/2018
Contract Detail	WALGREEN CO.	WALGREENS #19700	100 SOUTH HIGHWAY I 29	HOGANSVILLE	GA	30230	07/11/2019	10/01/2019	01/01/2020	01/01/2020
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/15/2014	07/01/2014	08/17/2015	08/27/2015
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/16/2015	10/01/2015	01/01/2020	01/01/2020
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/16/2015	10/01/2015	01/01/2020	01/01/2020
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/16/2015	10/01/2015	01/01/2020	01/01/2020
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/16/2015	10/01/2015	01/01/2020	01/01/2020

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH110229A	Child	DSH	Piedmont Newnan Hospital, Inc.	Piedmont Newnan Hospital Outpatient Infusion Center	775 Poplar Road	Newnan	GA	Terminated
DSH110229B	Child	DSH	Piedmont Newnan Hospital, Inc.	PIEDMONT NEWNAN CARDIOVASCULAR IMAG	20 FRANCIS WAY	SHARPSBURG	GA	Terminated
DSH110229C	Child	DSH	Piedmont Newnan Hospital, Inc.	PIEDMONT NEWNAN AMBULATORY SURGERY	775 POPLAR RD	NEWNAN	GA	Terminated
DSH110229D	Child	DSH	Piedmont Newnan Hospital, Inc.	PIEDMONT NEWNAN HEARTBURN CENTER	775 POPLAR ROAD	NEWNAN	GA	Terminated
DSH110229E	Child	DSH	Piedmont Newnan Hospital, Inc.	PIEDMONT OUTPATIENT CENTER	1755 HIGHWAY 34 EAST	NEWNAN	GA	Terminated
DSH110229F	Child	DSH	Piedmont Newnan Hospital, Inc.	PIEDMONT NEWNAN WOUND CARE	2401 NEWNAN CROSSING BOULEVARD EAST	NEWNAN	GA	Terminated
DSH110229G	Child	DSH	Piedmont Newnan Hospital, Inc.	RADIOLOGY ONCOLOGY SERVICES	775 Poplar Road	NEWNAN	GA	Terminated
DSH110229H	Child	DSH	Piedmont Newnan Hospital, Inc.	PIEDMONT NEWNAN FAYE HENDRIX-WARE BREAST HEALTH CENTER - MAMMOGRAPHY AND BREAST ULTRASOUND IMAGING	775 POPLAR ROAD	NEWNAN	GA	Terminated
DSH110229J	Child	DSH	Piedmont Newnan Hospital, Inc.	PIEDMONT NEWNAN HOSPITAL SLEEP CENTER - SLEEP STUDIES	20 FRANCIS WAY	SHARPSBURG	GA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2020 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		11/25/2019 12:00:00 AM	11/26/2019 1:53 PM
Details	State	Update	Termination Request	Active	To Be Terminated	11/26/2019 1:53 PM
Terminations	Termination Date	Update	Termination Request		1/1/2020 12:00:00 AM	11/26/2019 1:53 PM
Terminations	Termination Effective Date	Update	Termination Request		11/25/2019 12:00:00 AM	11/26/2019 1:53 PM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	11/26/2019 1:53 PM
Details	Last Recertification Date	Update	Recertification	8/22/2018 8:59:34 AM	9/3/2019 10:23:42 AM	9/3/2019 10:23 AM
Details	Last Recertification Date	Update	Recertification	12/4/2017 9:18:14 AM	8/22/2018 8:59:34 AM	8/22/2018 8:59 AM
Medicaid Billing	Medicaid: Number	Update	Change Request	492A	000000492A	7/13/2018 2:18 PM
Contacts	Authorizing Official	Update	Profile Change Request	Miles, John G. Vice President / CFO Piedmont Newnan Hospital 7704002336	Miles, John G. Vice President / CFO Piedmont Healthcare Multiple Hospital Entities 7704002336	7/6/2018 1:37 PM
Contacts	Signed By	Update	Profile Change Request	Miles, John G. Vice President / CFO Piedmont Newnan Hospital 7704002336	Miles, John G. Vice President / CFO Piedmont Healthcare Multiple Hospital Entities 7704002336	7/6/2018 1:37 PM
Details	Last Recertification Date	Update	Recertification	9/1/2016 12:00:00 AM	12/4/2017 9:18:14 AM	12/4/2017 9:18 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/21/2017 4:24 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		492A	9/21/2017 4:24 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	9/21/2017 4:24 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1134133002	9/21/2017 4:24 PM
Contacts	Authorizing Official	Update		Miles, John G. Vice President / CFO 7704002336	Miles, John G. Vice President / CFO Piedmont Newnan Hospital 7704002336	9/21/2017 4:15 PM
Contacts	Signed By	Update		Miles, John G. Vice President / CFO 7704002336	Miles, John G. Vice President / CFO Piedmont Newnan Hospital 7704002336	9/21/2017 4:15 PM
Contacts	Primary Contact	Update		Copelan, David Director of Pharmacy 7704002460	Copelan, David Director of Pharmacy Piedmont Newnan Hospital 7704002460	9/21/2017 3:31 PM
Contacts	Authorizing Official	Insert			Miles, John G. Vice President / CFO 7704002336	7/12/2017 8:15 AM
Contacts	Signed By	Insert			Miles, John G. Vice President / CFO 7704002336	7/12/2017 8:15 AM
Addresses	Main Address	Insert			745 Poplar Road Newnan, GA 30265	9/1/2016 10:37 AM
Contacts	Primary Contact	Insert			Copelan, David Director of Pharmacy 7704002460	9/1/2016 10:37 AM
Details	Last Recertification Date	Update		9/4/2015 12:00:00 AM	9/1/2016 12:00:00 AM	9/1/2016 10:37 AM
Details	Last Recertification Date	Update		8/29/2014 12:00:00 AM	9/4/2015 12:00:00 AM	9/4/2015 11:21 AM
Details	Last Recertification Date	Update		9/4/2013 12:00:00 AM	8/29/2014 12:00:00 AM	8/29/2014 10:23 AM
Details	Last Recertification Date	Update		9/4/2013 3:23:50 PM	9/4/2013 12:00:00 AM	4/18/2014 11:42 AM
Details	Last Recertification Date	Update			9/4/2013 3:23:50 PM	9/4/2013 3:23 PM
Details	340B ID	Update		ISDR-DSH110229	DSH110229	5/13/2013 1:06 PM
Dates	Participating Approval Date	Update			5/13/2013 12:00:00 AM	5/13/2013 1:06 PM
Details	State	Update		Pending	Active	5/13/2013 1:06 PM
Dates	Start Date	Update			7/1/2013 12:00:00 AM	5/13/2013 1:06 PM
Details	340B ID	Update		DR-DSH110229	ISDR-DSH110229	5/6/2013 2:12 PM
Details	340B ID	Update		DR040813E	DR-DSH110229	4/29/2013 3:06 PM
Details	340B ID	Update		ONLINE_REG	DR040813E	4/8/2013 4:34 PM
Details	Last Recertification Date	Insert				4/8/2013 11:16 AM
Details	Grant Number	Insert				4/8/2013 11:16 AM
Details	340B ID	Insert			ONLINE_REG	4/8/2013 11:16 AM
Details	Is Authorizing Official EHB Data	Insert				4/8/2013 11:16 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/8/2013 11:16 AM
Details	Medicare Provider Number	Insert			110229	4/8/2013 11:16 AM
Details	Entity Name	Insert			Piedmont Newnan Hospital, Inc.	4/8/2013 11:16 AM
Details	Program Code	Insert			DSH	4/8/2013 11:16 AM
Details	Entity Subname	Insert				4/8/2013 11:16 AM
Dates	Participating Approval Date	Insert				4/8/2013 11:16 AM
Details	State	Insert			Pending	4/8/2013 11:16 AM
Dates	Registration Date	Insert			4/8/2013 12:00:00 AM	4/8/2013 11:16 AM
Dates	Signed By Date	Insert			4/8/2013 12:00:00 AM	4/8/2013 11:16 AM
Dates	Start Date	Insert				4/8/2013 11:16 AM
Terminations	Termination Comments	Insert				4/8/2013 11:16 AM
Terminations	Termination Date	Insert				4/8/2013 11:16 AM
Terminations	Termination Effective Date	Insert				4/8/2013 11:16 AM
Terminations	Termination Reason	Insert				4/8/2013 11:16 AM