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CORAM ALTERNATE SITE SERVICES, INC.
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
CORAM ALTERNATE SITE SERVICES, INC.
Pharmacy Address
CORAM CVS/SPECIALTY INFUSION SERVICES
2140 NEWMARKET PARKWAY
SUITE 106
MARIETTA, GA 30067-8767
Pharmacy Comments
Contract Details
Approval Date
7/6/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/30/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Greg E. Anderson, CFO
(404) 686-2823
Contract Pharmacy Representative
Tonya Calhoun, Branch Manager
(770) 952-3021
Signed By Date
7/6/2017
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