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 #13641
35 COLLIER ROAD NW SUITE 100
ATLANTA, GA 30309

Pharmacy Comments

Contract Details

Approval Date

1/9/2018

Contract Begin Date

4/1/2018

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

1/9/2018

340B Drug Pricing Program Database