Contract Pharmacy Details

OPTUM INFUSION SERVICES 208, INC.
DSH110018 PIEDMONT NEWTON HOSPITAL, INC.

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 208, INC.

Pharmacy Address

556 ARBOR HILL RD STE F
KERNERSVILLE, NC 27284-3321

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

1/1/2025
Pharmacy closed

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

340B Drug Pricing Program Database