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PIEDMONT DIRECT PHARMACY LLC
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
PIEDMONT DIRECT PHARMACY LLC
Pharmacy Address
1510 PRINCE AVE STE A
ATHENS, GA 30606-6006
Pharmacy Comments
Contract Details
Approval Date
10/13/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marty Wynn, CFO
(770) 736-2420
Contract Pharmacy Representative
Piedmont Direct Pharmacy
Hugh Lynch, Director of Pharmacy
(706) 475-5563
Signed By Date
10/13/2022
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