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WALGREEN CO.
DSH110074 PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC
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Covered Entity Details
Entity Name
PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110074
Entity Address
1199 PRINCE AVENUE
ATHENS, GA 30606
Medicare Provider Number
110074
Participating Start Date
9/29/2005
Last Recertification Date
8/26/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA; WALGREENS #12886
3355 LEXINGTON ROAD
ATHENS, GA 30605
Pharmacy Comments
Contract Details
Approval Date
7/11/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/21/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
charles a peck, President and CEO
(650) 515-6301
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/11/2018
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