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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 # 04178
895 RALPH ABERNATHY BLVD., SW
ATLANTA, GA 30310
Pharmacy Comments
Contract Details
Approval Date
1/4/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/20/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Greg E. Anderson, CFO
(404) 686-2823
Contract Pharmacy Representative
CVS Health
Jaclyn Parfitt, 340B Operations Manager
(401) 770-6467
Signed By Date
1/4/2016
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