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WAL-MART PHARMACY 10-5997
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
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
7/12/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/23/2018
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
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/12/2017
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