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WALGREEN CO.
DSH110191 PIEDMONT HENRY HOSPITAL INC.
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Covered Entity Details
Entity Name
PIEDMONT HENRY HOSPITAL INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110191
Entity Address
1133 EAGLES LANDING PARKWAY
STOCKBRIDGE, GA 30281
Medicare Provider Number
110191
Participating Start Date
4/1/2023
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17028
2125 HIGHWAY 155 N
MCDONOUGH, GA 30252
Pharmacy Comments
Contract Details
Approval Date
7/16/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Wesley James, CFO
(678) 604-1001
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/16/2018
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