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CORAM HEALTHCARE CORPORATION OF ALABAMA
DSH110091 Piedmont Rockdale Hospital, Inc.
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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
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
10/4/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Marty Wynn, CFO
(770) 736-2420
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2020
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