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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
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
PRIME THERAPEUTICS SPECIALTY PHARMACY LL
Pharmacy Address
ALLIANCERX WALGREENS PRIME #16568
2354 COMMERCE PARK DRIVE
SUITE 100
ORLANDO, FL 32819-9992
Pharmacy Comments
Contract Details
Approval Date
7/10/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Covered Entity Terminated
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
7/10/2017
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