Contract Pharmacy Details

HEMOPHILIA OF GEORGIA
HM33612 JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.

Covered Entity Details

Entity Name

JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.

Subdivision Name

Johns Hopkins All Children's Outpatient Care, Tampa

Type

Comprehensive Hemophilia Treatment Center

340B ID

HM33612

Entity Address

12220 Bruce B Downs Blvd.
Tampa, FL 33612

Grant Number

H30MC24046

Participating Start Date

7/1/2018

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

HEMOPHILIA OF GEORGIA

Pharmacy Address

HEMOPHILIA OF GEORGIA
8607 ROBERTS DR STE 150A
SANDY SPRINGS, GA 30350-2238

Pharmacy Comments

Contract Details

Approval Date

5/18/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/27/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Roberta Alessi, VP & Chief Operating Officer
(727) 767-2868

Contract Pharmacy Representative

Hemophilia of Georgia
Edith A Rosato, CEO
(770) 518-8272

Signed By Date

4/11/2018

340B Drug Pricing Program Database