340B Drug Pricing Program Database
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DSH110074T 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 Royston OP DS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110074T
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
930 Franklin Springs Street
Royston, GA 30662
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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