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GEORGIA CVS PHARMACY, L.L.C.
DSH110078 EMORY UNIVERSITY HOSPITAL MIDTOWN
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Covered Entity Details
Entity Name
EMORY UNIVERSITY HOSPITAL MIDTOWN
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110078
Entity Address
550 PEACHTREE STREET, NE
ATLANTA, GA 30308-2209
Medicare Provider Number
110078
Participating Start Date
4/1/2006
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
GEORGIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04718
11625 JONES BRIDGE RD.
ALPHARETTA, GA 30022
Pharmacy Comments
Contract Details
Approval Date
4/23/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/4/2015
Agreement registered in error
Contacts
Covered Entity Signing Official
JAMES T. HATCHER Jr., CFO
(404) 686-7519
Contract Pharmacy Representative
CVS Caremark
JACKLYN PARFITT, MANAGER, PAYER RELATIONS
(401) 770-6467
Signed By Date
4/23/2015
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