340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH110046 PIEDMONT WALTON HOSPITAL, INC. (Terminated)
Print
Main Details
Name
PIEDMONT WALTON HOSPITAL, INC.
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110046
Medicare Provider Number
110046
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2019
Participating Start Date
4/1/2019
Participating Approval Date
1/28/2019
Last Recertification Date
8/23/2021
Termination Date
Termination Reason
1/1/2022
DSH percentage below statutory minimum
Contacts
Authorizing Official
Piedmont Eastside Medical Center
Marty Wynn, CFO
(770) 736-2420
Primary Contact
Piedmont Walton Hospital
Michael Wynne, Pharmacy Director
(770) 267-1714
Addresses
Street Address
2151 WEST SPRING STREET
MONROE, GA 30655
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
May 2025
May 2025
week
S
M
T
W
T
F
S
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
20
11
12
13
14
15
16
17
21
18
19
20
21
22
23
24
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session