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KROGER DRUGSTORE #388
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
KROGER DRUGSTORE #388
Pharmacy Address
564 CROSSTOWN DRIVE
PEACHTREE CITY, GA 30269
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/14/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
TROY B. BROOKS, CFO
(770) 385-4426
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
4/15/2014
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