340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PUBLIX SUPER MARKETS, INC.
DSH110091 Piedmont Rockdale Hospital, Inc.
Print
Covered Entity Details
Entity Name
Piedmont Rockdale Hospital, Inc.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110091
Entity Address
1412 Milstead Ave NE
CONYERS, GA 30012
Medicare Provider Number
110091
Participating Start Date
4/1/2019
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
PUBLIX SUPER MARKETS, INC.
Pharmacy Address
PUBLIX PHARMACY #1411
2159 HIGHWAY 20 SE
CONYERS, GA 30094
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/16/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Marty Wynn, CFO
(770) 736-2420
Contract Pharmacy Representative
Publix
Kimberly Bone, Manager of Managed Care, Pharmacy Operations
(863) 688-1188 Ext: 52364
Signed By Date
4/15/2019
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