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CORAM HEALTHCARE CORPORATION OF ALABAMA
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
CORAM HEALTHCARE CORPORATION OF ALABAMA
Pharmacy Address
DBA CORAM CVS/SPECIALTY INFUSION SERVICE
300 RIVERHILLS BUS PARK
SUITE 390
BIRMINGHAM, AL 35242-8101
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/21/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Jason Grady Smith, COO
(706) 475-1860
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2020
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