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GEORGIA CVS PHARMACY, L.L.C.
DSH110226 DEKALB MEDICAL CENTER AT HILLANDALE - DBA EMORY HILLANDALE HOSPITAL
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Covered Entity Details
Entity Name
DEKALB MEDICAL CENTER AT HILLANDALE - DBA EMORY HILLANDALE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110226
Entity Address
2801 DEKALB MEDICAL PARKWAY
LITHONIA, GA 30058
Medicare Provider Number
110226
Participating Start Date
10/1/2010
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
GEORGIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02116
7207 ROCKBRIDGE ROAD
STONE MOUNTAIN, GA 30087
Pharmacy Comments
Contract Details
Approval Date
1/13/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JOHN SHELTON, President and Chief Executive Officer
(404) 501-5209
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
1/13/2014
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