Contract Pharmacy Details

SORKIN'S RX LTD
DSH110046 PIEDMONT WALTON HOSPITAL, INC.

Covered Entity Details

Entity Name

PIEDMONT WALTON HOSPITAL, INC.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH110046

Entity Address

2151 WEST SPRING STREET
MONROE, GA 30655

Medicare Provider Number

110046

Participating Start Date

4/1/2019

Last Recertification Date

8/23/2021

Entity Termination Date

1/1/2022

Pharmacy Details

Pharmacy Name

SORKIN'S RX LTD

Pharmacy Address

D/B/A CAREMED PHARMACEUTICAL SERVICES
1985 MARCUS AVE STE 130
NEW HYDE PARK, NY 11042-2024

Pharmacy Comments

Contract Details

Approval Date

4/16/2020

Contract Begin Date

4/16/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

John G. Miles, Vice President / CFO
(770) 400-2336

Contract Pharmacy Representative

Onco360 Oncology Pharmacy
Jim Bozora, VP of 340B Oncology Sales
(702) 281-5985

Signed By Date

4/16/2020

340B Drug Pricing Program Database