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WALGREENS MAIL SERVICE, INC.
DSH110229 Piedmont Newnan Hospital, Inc.
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Covered Entity Details
Entity Name
Piedmont Newnan Hospital, Inc.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110229
Entity Address
745 Poplar Road
Newnan, GA 30265
Medicare Provider Number
110229
Participating Start Date
7/1/2013
Last Recertification Date
9/3/2019
Entity Termination Date
1/1/2020
Pharmacy Details
Pharmacy Name
WALGREENS MAIL SERVICE, INC.
Pharmacy Address
8350 S RIVER PARKWAY
TEMPE, AZ 85284
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
8/17/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John G. Miles, Vice President / CFO
(770) 400-2336
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2014
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