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KROGER DRUGSTORE #427
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
KROGER DRUGSTORE #427
Pharmacy Address
101 FAIRVIEW ROAD
ELLENWOOD, GA 30294
Pharmacy Comments
Contract Details
Approval Date
7/10/2019
Contract Begin Date
10/1/2019
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
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/10/2019
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