Contract Pharmacy Details

WALGREEN CO.
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

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 07742
1510 MILSTEAD AVE NE
CONYERS, GA 30012-3877

Pharmacy Comments

Contract Details

Approval Date

4/18/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

TROY B. BROOKS, CFO
(770) 385-4426

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/18/2017

340B Drug Pricing Program Database