340B Drug Pricing Program Database
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DSH110074V PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC (Terminated)
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Main Details
Name
PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC
Subdivision Name
Piedmont Athens Regional Lab Outreach - PAR Main Campus OP DS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110074V
Medicare Provider Number
110074
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/13/2020
Participating Start Date
1/1/2021
Participating Approval Date
11/18/2020
Last Recertification Date
9/8/2022
Termination Date
Termination Reason
7/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
Piedmont Athens Regional Medical Center
Jason Grady Smith, COO
(706) 475-1860
Primary Contact
Piedmont Athens Regional
Don Wesley Tyson, Director of Pharmacy
(706) 475-4438
Addresses
Street Address
242 King Avenue
First Floor
Athens, GA 30606
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
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May 2025
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