340B Drug Pricing Program Database


DSH110091A Piedmont Rockdale Hospital, Inc. (Active) - information as of 6/25/2025 12:48:20 AM

Main Details
Piedmont Rockdale Hospital, Inc.
Piedmont Rockdale Hospital - Outpatient Physical Therapy
Disproportionate Share Hospital
No
DSH110091A
110091


Additional Details
Active
1/14/2019
4/1/2019
1/16/2019
8/29/2024

Contacts

Piedmont Healthcare
Stewart Witherell, CFO
(770) 918-3101

Piedmont Rockdale Hospital, Inc.
Amanda Meriwether Miller, Director of Pharmacy
(770) 918-3752

Addresses

1290 Wellbrook Circle
Conyers, GA 30012

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
GA000001603A1306355680
Shipping Addresses

Same as Street Address
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH110091AChildDSHPiedmont Rockdale Hospital, Inc.Piedmont Rockdale Hospital - Outpatient Physical Therapy1290 Wellbrook CircleConyersGAActive
DSH110091BChildDSHPiedmont Rockdale Hospital, Inc.Piedmont Rockdale Hospital - Outpatient Speech Therapy1290 Wellbrook CircleConyersGAActive
DSH110091CChildDSHPiedmont Rockdale Hospital, Inc.Piedmont Oncology Institute - Oncology1412 Milstead Ave NEConyersGAActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification8/31/2023 8:53:01 AM8/29/2024 11:04:45 AM8/29/2024 11:04 AM
ContactsSigned ByUpdateProfile Change RequestWynn, Marty CFO Piedmont Rockdale Hospital 7709183101Wynn, Marty CFO Piedmont Eastside Medical Center 77073624201/17/2024 9:13 AM
ContactsAuthorizing OfficialUpdateChange RequestRoberts, Justin CFO Piedmont Rockdale Hospital 7709183101Witherell, Stewart CFO Piedmont Healthcare 770918310112/1/2023 12:56 PM
DetailsLast Recertification DateUpdateRecertification9/9/2022 9:49:43 AM8/31/2023 8:53:01 AM8/31/2023 8:53 AM
ContactsAuthorizing OfficialUpdateAO Change RequestWynn, Marty CFO Piedmont Rockdale Hospital 7709183101Roberts, Justin CFO Piedmont Rockdale Hospital 77091831018/30/2023 11:37 AM
DetailsLast Recertification DateUpdateRecertification8/20/2021 11:01:54 AM9/9/2022 9:49:43 AM9/9/2022 9:49 AM
DetailsLast Recertification DateUpdateRecertification9/10/2020 7:55:38 AM8/20/2021 11:01:54 AM8/20/2021 11:01 AM
Medicaid BillingNPI: StateUpdateRecertification GA9/10/2020 7:55 AM
DetailsLast Recertification DateUpdateRecertification8/19/2019 9:35:24 AM9/10/2020 7:55:38 AM9/10/2020 7:55 AM
DetailsLast Recertification DateUpdateRecertification 8/19/2019 9:35:24 AM8/19/2019 9:35 AM
DetailsStateUpdate ApprovedActive4/1/2019 12:05 AM
DetailsEntity NameUpdateChange RequestROCKDALE MEDICAL CENTERPiedmont Rockdale Hospital, Inc.3/6/2019 8:11 AM
DetailsEntity NameUpdateReinstatementROCKDALE HOSPITAL DBA ROCKDALE MEDICAL CENTERROCKDALE MEDICAL CENTER1/22/2019 2:41 PM
ContactsSigned ByInsertNew Registration Wynn, Marty CFO Piedmont Rockdale Hospital 77091831011/16/2019 11:36 AM
Details340B IDUpdateNew Registration DSH110091A1/16/2019 11:36 AM
DetailsEntity NameUpdateNew RegistrationROCKDALE MEDICAL CENTERROCKDALE HOSPITAL DBA ROCKDALE MEDICAL CENTER1/16/2019 11:36 AM
DetailsEntity SubnameUpdateNew RegistrationPiedmont Rockdale HospitalPiedmont Rockdale Hospital - Outpatient Physical Therapy1/16/2019 11:36 AM
DatesParticipating Approval DateUpdateNew Registration 1/16/2019 11:36:22 AM1/16/2019 11:36 AM
DetailsStateUpdateNew RegistrationPendingApproved1/16/2019 11:36 AM
DatesSigned By DateUpdateNew Registration 1/15/2019 4:14:57 PM1/16/2019 11:36 AM
DatesStart DateUpdateNew Registration 4/1/2019 12:00:00 AM1/16/2019 11:36 AM
AddressesMain AddressInsertNew Registration  1290 Wellbrook Circle Conyers, GA 300121/14/2019 5:19 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/14/2019 5:19 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 000001603A1/14/2019 5:19 PM
Medicaid BillingMedicaid: StateInsertNew Registration GA1/14/2019 5:19 PM
Medicaid BillingNPI: NumberInsertNew Registration 13063556801/14/2019 5:19 PM
ContactsPrimary ContactInsertNew Registration Miller, Amanda Meriwether Director of Pharmacy Piedmont Rockdale Hospital, Inc. 77091837521/14/2019 5:19 PM
ContactsAuthorizing OfficialInsertNew Registration Wynn, Marty CFO Piedmont Rockdale Hospital 77091831011/14/2019 5:19 PM
DetailsLast Recertification DateInsertNew Registration  1/14/2019 5:19 PM
DetailsGrant NumberInsertNew Registration  1/14/2019 5:19 PM
Details340B IDInsertNew Registration  1/14/2019 5:19 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  1/14/2019 5:19 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  1/14/2019 5:19 PM
DetailsMedicare Provider NumberInsertNew Registration 1100911/14/2019 5:19 PM
DetailsEntity NameInsertNew Registration ROCKDALE MEDICAL CENTER1/14/2019 5:19 PM
DetailsProgram CodeInsertNew Registration DSH1/14/2019 5:19 PM
DetailsEntity SubnameInsertNew Registration Piedmont Rockdale Hospital1/14/2019 5:19 PM
DatesParticipating Approval DateInsertNew Registration  1/14/2019 5:19 PM
DetailsStateInsertNew Registration Pending1/14/2019 5:19 PM
DatesRegistration DateInsertNew Registration 1/14/2019 5:19:59 PM1/14/2019 5:19 PM
DatesSigned By DateInsertNew Registration  1/14/2019 5:19 PM
DatesStart DateInsertNew Registration  1/14/2019 5:19 PM
TerminationsTermination CommentsInsertNew Registration  1/14/2019 5:19 PM
TerminationsTermination DateInsertNew Registration  1/14/2019 5:19 PM
TerminationsTermination Effective DateInsertNew Registration  1/14/2019 5:19 PM
TerminationsTermination ReasonInsertNew Registration  1/14/2019 5:19 PM