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OPTION CARE ENTERPRISES, INC.
DSH110018 PIEDMONT NEWTON HOSPITAL, INC.
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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
OPTION CARE ENTERPRISES, INC.
Pharmacy Address
OPTION CARE
5854 PEACHTREE CORNERS EAST
SUITE 200
PEACHTREE CORNERS, GA 30092-3410
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
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
Option Care
Derek Bilyk, Program Manager, Health Systems
(224) 813-1283
Signed By Date
1/15/2018
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