Covered Entity Details

DSH110018C PIEDMONT NEWTON HOSPITAL, INC. (Active) - information as of 5/23/2025 12:08:02 AM

Main Details

Name

PIEDMONT NEWTON HOSPITAL, INC.

Subdivision Name

Piedmont Newton Hospital Women's Diagnostic Center - Mammography

Type

Disproportionate Share Hospital

Rural

340B ID

DSH110018C

Medicare Provider Number

110018

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/10/2019

Participating Start Date

7/1/2019

Participating Approval Date

4/11/2019

Last Recertification Date

8/16/2024

Contacts

Authorizing Official

Piedmont Newton Hospital
Lindsey H. Petrini, Chief Executive Officer
(770) 787-9059

Primary Contact

Piedmont Newton Hospital
Leigh Wilson, Director of Pharmacy
(770) 385-4459

Addresses

Street Address

4181 Hospital Drive
301
Covington, GA 30014

Billing Address

Piedmont Newton Hospital
5126 HOSPITAL DRIVE NE
COVINGTON, GA 30014

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	000001394A	1760498588

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH110018A	Child	DSH	PIEDMONT NEWTON HOSPITAL	MRI Center	5207 Hwy 278	Covington	GA	Terminated
DSH110018B	Child	DSH	PIEDMONT NEWTON HOSPITAL	EAST ATLANTA HEMAOLOGY & ONCOLOGY	10157 EAGLE DRIVE	COVINGTON	GA	Terminated
DSH110018C	Child	DSH	PIEDMONT NEWTON HOSPITAL, INC.	Piedmont Newton Hospital Women's Diagnostic Center - Mammography	4181 Hospital Drive	Covington	GA	Active
DSH110018D	Child	DSH	PIEDMONT NEWTON HOSPITAL, INC.	Piedmont Newton Hospital Imaging Center - Outpatient Diagnostic Center - MRI	5207 Highway 278	Covington	GA	Active
DSH110018E	Child	DSH	PIEDMONT NEWTON HOSPITAL, INC.	Piedmont Newton Rheumatology - Rheumatology	4181 Hospital Drive NE	COVINGTON	GA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Witherell, Stewart CFO Piedmont Healthcare 7709183101	Petrini, Lindsey H. Chief Executive Officer Piedmont Newton Hospital 7707879059	9/26/2024 9:39 AM
Details	Last Recertification Date	Update	Recertification	8/17/2023 2:49:25 PM	8/16/2024 12:11:05 PM	8/16/2024 12:11 PM
Contacts	Authorizing Official	Update	Change Request	Roberts, Justin CFO Piedmont Rockdale Hospital 7709183101	Witherell, Stewart CFO Piedmont Healthcare 7709183101	12/1/2023 1:12 PM
Addresses	Billing Address	Insert	Group Change Request		Piedmont Newton Hospital 5126 HOSPITAL DRIVE NE COVINGTON, GA 30014	8/30/2023 11:29 AM
Details	Last Recertification Date	Update	Recertification	9/8/2022 7:28:57 AM	8/17/2023 2:49:25 PM	8/17/2023 2:49 PM
Contacts	Authorizing Official	Update	Change Request	Wynn, Marty CFO Piedmont Rockdale Hospital 7709183101	Roberts, Justin CFO Piedmont Rockdale Hospital 7709183101	7/5/2023 1:01 PM
Details	Last Recertification Date	Update	Recertification	8/20/2021 11:00:59 AM	9/8/2022 7:28:57 AM	9/8/2022 7:28 AM
Details	Last Recertification Date	Update	Recertification	9/10/2020 7:54:47 AM	8/20/2021 11:00:59 AM	8/20/2021 11:00 AM
Medicaid Billing	NPI: State	Update	Recertification		GA	9/10/2020 7:54 AM
Details	Last Recertification Date	Update	Recertification	9/3/2019 10:18:13 AM	9/10/2020 7:54:47 AM	9/10/2020 7:54 AM
Contacts	Authorizing Official	Update	Change Request	Miles, John G. Vice President / CFO Piedmont Healthcare Multiple Hospital Entities 7704002336	Wynn, Marty CFO Piedmont Rockdale Hospital 7709183101	8/14/2020 3:06 PM
Details	Last Recertification Date	Update	Recertification		9/3/2019 10:18:13 AM	9/3/2019 10:18 AM
Details	State	Update		Approved	Active	7/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Miles, John G. Vice President / CFO Piedmont Healthcare Multiple Hospital Entities 7704002336	4/11/2019 2:20 PM
Details	340B ID	Update	New Registration		DSH110018C	4/11/2019 2:20 PM
Details	Entity Name	Update	New Registration	PIEDMONT NEWTON HOSPITAL	PIEDMONT NEWTON HOSPITAL, INC.	4/11/2019 2:20 PM
Details	Entity Subname	Update	New Registration	Piedmont Newton Hospital Women's Diagnostic Center	Piedmont Newton Hospital Women's Diagnostic Center - Mammography	4/11/2019 2:20 PM
Dates	Participating Approval Date	Update	New Registration		4/11/2019 2:20:11 PM	4/11/2019 2:20 PM
Details	State	Update	New Registration	Pending	Approved	4/11/2019 2:20 PM
Dates	Signed By Date	Update	New Registration		4/10/2019 3:51:04 PM	4/11/2019 2:20 PM
Dates	Start Date	Update	New Registration		7/1/2019 12:00:00 AM	4/11/2019 2:20 PM
Addresses	Main Address	Insert	New Registration		4181 Hospital Drive 301 Covington, GA 30014	4/10/2019 12:11 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2019 12:11 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		000001394A	4/10/2019 12:11 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		GA	4/10/2019 12:11 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1760498588	4/10/2019 12:11 AM
Contacts	Authorizing Official	Insert	New Registration		Miles, John G. Vice President / CFO Piedmont Healthcare Multiple Hospital Entities 7704002336	4/10/2019 12:11 AM
Contacts	Primary Contact	Insert	New Registration		Wilson, Leigh Director of Pharmacy Piedmont Newton Hospital 7703854459	4/10/2019 12:11 AM
Details	Last Recertification Date	Insert	New Registration			4/10/2019 12:11 AM
Details	Grant Number	Insert	New Registration			4/10/2019 12:11 AM
Details	340B ID	Insert	New Registration			4/10/2019 12:11 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/10/2019 12:11 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/10/2019 12:11 AM
Details	Medicare Provider Number	Insert	New Registration		110018	4/10/2019 12:11 AM
Details	Entity Name	Insert	New Registration		PIEDMONT NEWTON HOSPITAL	4/10/2019 12:11 AM
Details	Program Code	Insert	New Registration		DSH	4/10/2019 12:11 AM
Details	Entity Subname	Insert	New Registration		Piedmont Newton Hospital Women's Diagnostic Center	4/10/2019 12:11 AM
Dates	Participating Approval Date	Insert	New Registration			4/10/2019 12:11 AM
Details	State	Insert	New Registration		Pending	4/10/2019 12:11 AM
Dates	Registration Date	Insert	New Registration		4/10/2019 12:11:54 AM	4/10/2019 12:11 AM
Dates	Signed By Date	Insert	New Registration			4/10/2019 12:11 AM
Dates	Start Date	Insert	New Registration			4/10/2019 12:11 AM
Terminations	Termination Comments	Insert	New Registration			4/10/2019 12:11 AM
Terminations	Termination Date	Insert	New Registration			4/10/2019 12:11 AM
Terminations	Termination Effective Date	Insert	New Registration			4/10/2019 12:11 AM
Terminations	Termination Reason	Insert	New Registration			4/10/2019 12:11 AM