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OPTUM INFUSION SERVICES 209, INC.
DSH110018 PIEDMONT NEWTON HOSPITAL, INC.
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Covered Entity Details
Entity Name
PIEDMONT NEWTON HOSPITAL, INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110018
Entity Address
5126 HOSPITAL DRIVE
COVINGTON, GA 30014
Medicare Provider Number
110018
Participating Start Date
1/1/2011
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
OPTUM INFUSION SERVICES 209, INC.
Pharmacy Address
425 FRANKLIN GATEWAY
SUITE 535
MARIETTA, GA 30067-7736
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/12/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Marty Wynn, CFO
(770) 736-2420
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2021
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