Contract Pharmacy Details

KROGER PHARMACY #694
DSH110018 PIEDMONT NEWTON HOSPITAL, INC.

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 PHARMACY #694

Pharmacy Address

2809 N. COLUMBIA ST.
MILLEDGEVILLE, GA 31061

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

340B Drug Pricing Program Database