Contract Pharmacy Details

GEORGIA CVS PHARMACY, L.L.C.
DSH110229 Piedmont Newnan Hospital, Inc.

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

GEORGIA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02544
101 LEXINGTON CIRCLE
PEACHTREE CITY, GA 30269

Pharmacy Comments

Contract Details

Approval Date

7/11/2017

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

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/11/2017

340B Drug Pricing Program Database