Covered Entity Details

CH04580G GOSHEN MEDICAL CENTER, INC. (Active) - information as of 5/14/2025 10:51:54 PM

Main Details

Name

GOSHEN MEDICAL CENTER, INC.

Subdivision Name

GOSHEN MEDICAL CENTER - BEULAVILLE

Type

HRSA-Funded Health Center

Site ID

BPS-H80-000250

340B ID

CH04580G

Grant Number

H80CS00181

Additional Details

Current Program Status

Active

Registration Date

10/1/2004

Participating Start Date

10/1/2004

Participating Approval Date

9/10/2004

Last Recertification Date

3/10/2025

Contacts

Authorizing Official

Goshen Medical Center, Inc.
Rhonda Barwick, Deputy CEO
(910) 267-1942

Primary Contact

Goshen Medical Center, Inc.
Brittany Parent, 340B Administrative Assistant
(910) 267-0421 Ext: 1348

Addresses

Street Address

119 CROSSOVER RD
BEULAVILLE, NC 28518-8801

Billing Address

GOSHEN MEDICAL CENTER, INC.
PO BOX 187
FAISON, NC 28341

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
NEW SITE 10/01/2004	08/12/2005

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
NC	1558008664	1558008664

Shipping Addresses

Shipping Address 1

GMC Pharmacy at Beulaville
119 Crossover Road
Beulaville, NC 28518

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
Contract Detail	BEULAVILLE PHARMACY, INC	103 CROSSOVER RD		BEULAVILLE	NC	28518-8801	03/13/2009	03/13/2009		08/17/2022	01/22/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH045800	Active	BPS-H80-003635	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER, INC.	444 SW Center St	Faison	NC
CH04580A	Active	BPS-H80-004788	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - PLAINVIEW HEALTH SERVICES	360 E. CHARITY RD	ROSE HILL	NC
CH04580AA	Active	BPS-H80-013666	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - CAPE FEAR	3613 CAPE CENTER DR	FAYETTEVILLE	NC
CH04580AB	Active	BPS-H80-013970	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - FAIRVIEW	408 FAIRVIEW ST	CLINTON	NC
CH04580AC	Active	BPS-H80-011361	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - ROSEWOOD	104A Adair Drive	GOLDSBORO	NC
CH04580AD	Active	BPS-H80-021523	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - TABOR CITY	270 N US Highway 701 Byp	TABOR CITY	NC
CH04580AE	Active	BPS-H80-014905	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - CHADBOURN	110 N BROWN ST	CHADBOURN	NC
CH04580AF	Terminated	BPS-H80-018861	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - VINELAND	630 S Madison Street	Whiteville	NC
CH04580AG	Active	BPS-H80-027020	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - SOUTHPORT	4654 Long Beach Rd SE	Southport	NC
CH04580AH	Terminated	BPS-H80-021538	Goshen Medical Center, Inc.	GOSHEN MEDICAL CENTER - COLUMBUS PEDIATRICS	800 Jefferson St Ste 116	Whiteville	NC
CH04580AJ	Active	BPS-H80-024428	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - ROCKINGHAM	125 Biltmore Dr Ste 1	Rockingham	NC
CH04580AK	Active	BPS-H80-022069	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - KENANSVILLE	102 N Main Street, Suites 1 & 2	Kenansville	NC
CH04580AL	Active	BPS-H80-019686	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - HAMLET	106 JEFFERSON ST.	Hamlet	NC
CH04580AM	Active	BPS-H80-021014	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - MOBILE DENTAL	460 SW Center Street	Faison	NC
CH04580AN	Active	BPS-H80-021015	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - MOBILE MEDICAL	444 SW Center Street	Faison	NC
CH04580AP	Active	BPS-H80-021030	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - DUNN	801 Tilghman Dr Ste A	Dunn	NC
CH04580AQ	Active	BPS-H80-027769	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - RAEFORD	102 W Southern Ave	Raeford	NC
CH04580AR	Active	BPS-H80-028297	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - ROSEWOOD DENTAL SERVICES	104C Adair Dr	Goldsboro	NC
CH04580AS	Active	BPS-H80-032584	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - FAYETTEVILLE	1248 Fort Bragg Rd Ste 200	Fayetteville	NC
CH04580AT	Active	BPS-H80-032673	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - APEX	1624 White Oak Church Rd	Apex	NC
CH04580AU	Active	BPS-H80-034063	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - ELIZABETHTOWN	400 Mercer Mill Rd	Elizabethtown	NC
CH04580AV	Active	BPS-H80-034902	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - ALBEMARLE	1000 N 5th St	Albemarle	NC
CH04580AW	Active	BPS-H80-036157	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - MOREHEAD CITY	202 Penny Ln	Morehead City	NC
CH04580AX	Active	BPS-H80-035496	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - SANFORD	2807 S Horner Blvd	Sanford	NC
CH04580AY	Active	BPS-H80-036450	Goshen Medical Center, Inc.	GOSHEN MEDICAL CENTER - STAR	103 Cotton Creek Rd	Star	NC
CH04580AZ	Active	BPS-H80-036220	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - DUPLIN	214 Duplin St	Kenansville	NC
CH04580B	Active	BPS-H80-001640	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - COMMUNITY HEALTH SERVICES	325 NORTH CAROLINA 55 WEST	MOUNT OLIVE	NC
CH04580BA	Active	BPS-H80-037252	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - JACKSONVILLE	158 Memorial Ct	Jacksonville	NC
CH04580BB	Active	BPS-H80-032837	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - MOUNT OLIVE MOBILE UNIT	325 NC Highway 55 W	Mount Olive	NC
CH04580BC	Active	BPS-H80-032838	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - DUNN MOBILE UNIT	801 Tilghman Dr Ste A	Dunn	NC
CH04580BD	Active	BPS-H80-035495	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - SANFORD MOBILE UNIT	2807 S Horner Blvd	Sanford	NC
CH04580BE	Active	BPS-H80-032841	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - RAEFORD MOBILE UNIT	102 W Southern Ave	Raeford	NC
CH04580BF	Active	BPS-H80-035875	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - HAMPSTEAD MOBILE UNIT	261 Sloop Point Loop Rd	Hampstead	NC
CH04580BG	Active	BPS-H80-032839	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - HAMLET MOBILE UNIT	106 Jefferson St	Hamlet	NC
CH04580BH	Active	BPS-H80-032835	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - WHITEVILLE MOBILE UNIT	5 Whiteville Town Ctr	Whiteville	NC
CH04580BJ	Active	BPS-H80-034365	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - NEW RIVER MOBILE UNIT	1200 HARGETT ST	JACKSONVILLE	NC
CH04580BK	Active	BPS-H80-034366	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - NEW BERN MOBILE UNIT	4007 M L King Jr Blvd	New Bern	NC
CH04580BL	Active	BPS-H80-032836	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - CLINTON MOBILE UNIT	906 N US HWY 421	Clinton	NC
CH04580BM	Active	BPS-H80-039007	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - BRIDGETON	530 Nc 55 Highway East	New Bern	NC
CH04580BN	Active	BPS-H80-034187	GOSHEN MEDICAL CENTER, INC	GOSHEN MEDICAL CENTER - ELIZABETHTOWN MOBILE UNIT	400 Mercer Mill Rd	Elizabethtown	NC
CH04580D	Active	BPS-H80-002522	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - WARSAW	603 E. COLLEGE ST	WARSAW	NC
CH04580F	Active	BPS-H80-004910	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - CLINTON	906 N US HWY 421	CLINTON	NC
CH04580G	Active	BPS-H80-000250	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - BEULAVILLE	119 CROSSOVER RD	BEULAVILLE	NC
CH04580H	Terminated	BPS-H80-009342	GOSHEN MEDICAL CENTER, INC.	Goshen Medical Center - Women's Health	212 Duplin St	Kenansville	NC
CH04580J	Active	BPS-H80-008898	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - WARSAW WELLNESS CENTER	113 S Pine St	Warsaw	NC
CH04580K	Terminated	BPS-H80-000983	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - SAMPSON	516 BEAMAN ST	CLINTON	NC
CH04580L	Active	BPS-H80-003568	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - LAMBERTS	130 NE Center St	Mount Olive	NC
CH04580M	Active	BPS-H80-002088	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - GOLDSBORO	2701 Medical Office Pl	Goldsboro	NC
CH04580N	Terminated	BPS-H80-009510	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER-EASTPOINTE	200 W Ash St STE 202	Goldsboro	NC
CH04580P	Terminated	BPS-H80-009354	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CTR - TRENTON	104 E Lakeview Dr	Trenton	NC
CH04580R	Active	BPS-H80-005011	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - GARLAND	105 SOUTH LISBON AVE	GARLAND	NC
CH04580S	Active	BPS-H80-005040	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - BOLTON	213 9th St	Bolton	NC
CH04580T	Active	BPS-H80-009334	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - FREMONT	109 S Sycamore St	Fremont	NC
CH04580U	Active	BPS-H80-002897	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - FAISON DENTAL SERVICES	460 SW Center St	Faison	NC
CH04580V	Active	BPS-H80-008820	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - CLINTON DENTAL SERVICES	908 N US Hwy 421	Clinton	NC
CH04580W	Active	BPS-H80-008712	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - WALLACE	110 Eastwood Dr	Wallace	NC
CH04580X	Active	BPS-H80-011111	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - NEW RIVER	1200 HARGETT ST	JACKSONVILLE	NC
CH04580Y	Active	BPS-H80-021392	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - WHITEVILLE	5 Whiteville Town Ctr	WHITEVILLE	NC
CH04580Z	Active	BPS-H80-032093	GOSHEN MEDICAL CENTER, INC.	GOSHEN MEDICAL CENTER - NEW BERN	4007 M L KING JR BLVD	NEW BERN	NC

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH045800	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	01/01/2025
CH04580G	BEULAVILLE PHARMACY, INC	103 CROSSOVER RD		BEULAVILLE	NC	28518-8801	03/13/2009	08/17/2022
CH045800	BLSRPH, INC.	D/B/A VILLAGE PRESCRIPTION CENTER	108 E. OLD HIGHWAY 74 76 P.O. BOX 148	LAKE WACCAMAW	NC	28450-2512	10/01/2022
CH045800	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2023
CH045800	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2023
CH045800	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2023
CH045800	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2023
CH045800	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2023
CH045800	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2023
CH045800	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2023
CH045800	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2023
CH045800	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2023
CH045800	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2023
CH045800	CENTER STREET PHARMACY	128 N E CENTER STREET		MOUNT OLIVE	NC	28365	11/10/2011	11/01/2017
CH045800	CRX, INC.	CROSSROADS PHARMACY	20 WHITEVILLE TOWN CTR	WHITEVILLE	NC	28472-4401	10/01/2022	01/31/2024
CH045800	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2022
CH045800	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2022
CH045800	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2023
CH045800	DOWNTOWN PHARMACY	151 N CENTER ST		GOLDSBORO	NC	27530-3620	07/01/2019
CH045800	FAISON PHARMACY	206 SW CENTER ST		FAISON	NC	28341	07/01/2003	07/23/2021
CH04580F	FAISON PHARMACY	206 SW CENTER ST		FAISON	NC	28341	10/01/2004	07/23/2021
CH045800	FOOD LION, LLC	DBA FOOD LION PHARMACY #2581	4700 HWY 117 NORTH	PIKEVILLE	NC	27863	10/01/2022
CH045800	FREMONT PHARMACY	FREMONT PHARMACY	113 E MAIN ST	FREMONT	NC	27830-9498	01/01/2014	12/13/2021
CH045800	GRAHAM DRUG CO		116 E MAIN ST	WALLACE	NC	28466	05/02/2011	07/01/2016
CH045800	HCC PHARMACY-DME	HCC PHARMACY INC	402 S MAIN ST	RAEFORD	NC	28376	07/01/2020	07/29/2022
CH045800	KENANSVILLE PHARMACY	134 LIBERTY SQ STE B		KENANSVILLE	NC	28349	10/01/2017
CH045800	MARMAC PHARMACY	110 FIVE POINTS RD		GOLDSBORO	NC	27530-0916	10/01/2017
CH045800	MT. OLIVE PHARMACY	615 N. BREAZEALE AVENUE		MOUNT OLIVE	NC	28365	05/02/2011
CH04580B	MT. OLIVE PHARMACY	615 N. BREAZEALE AVENUE		MOUNT OLIVE	NC	28365	10/01/2004	01/31/2024
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07021	2203 WAYNE MEMORIAL DR.	GOLDSBORO	NC	27534	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04095	3026 BRAGG BLVD.	FAYETTEVILLE	NC	28303	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03864	3100 LEGION RD.	HOPE MILLS	NC	28348	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04169	522 OWEN DR	FAYETTEVILLE	NC	28304	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07043	634 S. MAIN ST.	KENANSVILLE	NC	28349	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04435	9539 CLIFFDALE RD	FAYETTEVILLE	NC	28304	10/01/2022	03/05/2025
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04293	4923 RAEFORD RD.	FAYETTEVILLE	NC	28304	10/01/2022	03/20/2025
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07314	507 COLLEGE STREET	CLINTON	NC	28328	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05585	400 WESTERN BLVD.	JACKSONVILLE	NC	28546	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05504	100 LAW ROAD	FAYETTEVILLE	NC	28311	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05594	2400 GUM BRANCH RD.	JACKSONVILLE	NC	28540	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05577	218 EAST MAIN STREET	WALLACE	NC	28466	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07163	3966 S. MAIN STREET	HOPE MILLS	NC	28348	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03815	1156 E. CASWELL STREET	WADESBORO	NC	28170	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07332	1206 E. BROAD AVE.	ROCKINGHAM	NC	28379	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS/PHARMACY #11349	1106B MAIN STREET EXTENTION	SWANSBORO	NC	28584-9114	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16373	1204 SUNBURST DR	GOLDSBORO	NC	27534	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16581	1395D WESTERN BLVD	JACKSONVILLE	NC	28546	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07570	902 N. J.K. POWELL BLVD.	WHITEVILLE	NC	28472	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07313	230 COLE AVE	RAEFORD	NC	28376	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07382	5006 SOUTHPORT CROSSING WAY	SOUTHPORT	NC	28461	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07500	80 W. JACKSON BLVD.	ERWIN	NC	28339	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16231	2056 SKIBO RD	FAYETTEVILLE	NC	28314	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07597	803 SOUTH MAIN ST.	LILLINGTON	NC	27546	10/01/2022
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07540	404 RAMSEY ST.	FAYETTEVILLE	NC	28301	10/01/2022	04/01/2025
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05508	371 S. POPLAR ST. / PO BOX 2066	ELIZABETHTOWN	NC	28337	07/01/2023
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05597	3311 MARTIN LUTHER KING JR. BLVD.	NEW BERN	NC	28562	07/01/2023
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05545	1115 US HWY 64, PO BOX 1877	MANTEO	NC	27954	01/01/2025	03/26/2025
CH045800	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07361	1101 S. CROATAN HWY	KILL DEVIL HILLS	NC	27948	01/01/2025	03/26/2025
CH045800	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	10/01/2022
CH045800	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2025
CH045800	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	07/01/2025
CH045800	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	10/01/2022	12/31/2024
CH045800	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2023
CH045800	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2023
CH045800	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	04/01/2023
CH045800	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2023
CH045800	PROCARE PHARMACY, LLC	DBA CVS/PHARMACY#2980	601 S. KINGS DR.	CHARLOTTE	NC	28204	10/01/2022
CH045800	REALO DISCOUNT DRUG	300 N QUEEN ST		KINSTON	NC	28501	07/01/2020	06/30/2022
CH045800	REALO DISCOUNT DRUG	1302 W VERNON AVE		KINSTON	NC	28504-3528	07/01/2020
CH045800	REALO DISCOUNT DRUG STORES OF EASTERN NC	DBA REALO DISCOUNT DRUGS	103 CROSSOVER RD	BEULAVILLE	NC	28518	08/18/2022	05/08/2024
CH045800	REALO DISCOUNT DRUG STORES OF EASTERN NO	CAROLINA INC	2680 HENDERSON DR DBA REALO DISCOUNT DRUGS	JACKSONVILLE	NC	28546	07/01/2015
CH045800	REALO DISCOUNT DRUG STORES OF EASTERN NO	CAROLINA INC	D/B/A REALO DISCOUNT DRUGS 5655 S NC 41 HWY	WALLACE	NC	28466	07/01/2015
CH045800	REALO DISCOUNT DRUG STORES OF GREENE CO.	104 PARKWOOD DR		SNOW HILL	NC	28580-1336	07/01/2020	06/30/2022
CH045800	REALO DISCOUNT DRUGS	515 E NEW HOPE RD		GOLDSBORO	NC	27534-7004	07/01/2020	09/22/2020
CH045800	REALO DISCOUNT DRUGS OF ONSLOW, INC	423 YOPP RD STE 200		JACKSONVILLE	NC	28540-3594	07/01/2015
CH045800	ROSEWOOD PHARMACY	D & J DRUGS INC	514 NC 581 HWY S	GOLDSBORO	NC	27530-7854	10/01/2017
CH045800	SAM'S PHARMACY		P.O. BOX 1086 110 S. SYCAMORE ST	ROSE HILL	NC	28458	05/02/2011	07/01/2016
CH04580A	SAM'S PHARMACY		P.O. BOX 1086 110 S. SYCAMORE ST	ROSE HILL	NC	28458	10/01/2004	07/01/2016
CH04580D	SAM'S PHARMACY		P.O. BOX 1086 110 S. SYCAMORE ST	ROSE HILL	NC	28458	10/01/2004	07/01/2016
CH045800	VALUE RX PHARMACY	VALUE RX PHARMACY	107 S PINE ST	WARSAW	NC	28398	05/02/2011
CH045800	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2020
CH045800	WAL-MART PHARMACY #10-1261	4601 RAMSEY STREET		FAYETTEVILLE (NE)	NC	28311	04/01/2020
CH045800	WAL-MART PHARMACY 10-1010	720 E. HWY 74 BUSINESS		ROCKINGHAM	NC	28379	04/01/2020
CH045800	WAL-MART PHARMACY 10-1236	1002 N. SPENCE AVE		GOLDSBORO	NC	27534	04/01/2020
CH045800	WAL-MART PHARMACY 10-1237	590 JACKSON BLVD		ERWIN	NC	28339	04/01/2020
CH045800	WAL-MART PHARMACY 10-1268	200 COLUMBUS CORNERS DR		WHITEVILLE	NC	28472	04/01/2020
CH045800	WAL-MART PHARMACY 10-1352	5625 SOUTH NC HWY 41		WALLACE	NC	28466	04/01/2020
CH045800	WAL-MART PHARMACY 10-1661	4101 W. VERNON AVE		KINSTON	NC	28504-9672	10/01/2022
CH045800	WAL-MART PHARMACY 10-2580	1415 SUNSET AVENUE		CLINTON	NC	28328	04/01/2020
CH045800	WAL-MART PHARMACY 10-2929	3030 NORTH MAIN		HOPE MILLS	NC	28348	10/01/2022
CH045800	WAL-MART PHARMACY 10-3701	308 NC 55 WEST		MOUNT OLIVE	NC	28365	04/01/2020
CH045800	WAL-MART PHARMACY 10-4564	2908 US HWY 70 WEST		GOLDSBORO	NC	27530	04/01/2020
CH045800	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2020
CH045800	WAL-MART PHARMACY 10-7334	4350 US 70 HWY EAST		GOLDSBORO	NC	27534	10/01/2022
CH045800	WALGREEN CO	DBA: WALGREENS #11352	1019 GRANDIFLORA DRIVE	LELAND	NC	28451	11/01/2011
CH045800	WALGREEN CO.	DBA: WALGREENS # 09348	1600 GUM BRANCH RD	JACKSONVILLE	NC	28540	11/01/2011
CH045800	WALGREEN CO.	DBA: WALGREENS # 07748	359 WESTERN BLVD	JACKSONVILLE	NC	28546-6347	11/01/2011
CH045800	WALGREEN CO.	DBA: WALGREENS #12133	3069 RICHLANDS HWY.	JACKSONVILLE	NC	28540	11/01/2011
CH045800	WALGREEN CO.	DBA: WALGREENS # 09288	2202 WAYNE MEMORIAL DR	GOLDSBORO	NC	27534	11/01/2011
CH045800	WALGREEN CO.	DBA: WALGREENS # 07622	2606 E ASH STREET	GOLDSBORO	NC	27534-4515	11/01/2011
CH045800	WALGREEN CO.	DBA: WALGREENS #11893	115 W. MAIN ST.	BEULAVILLE	NC	28518	11/01/2011
CH045800	WALGREEN CO.	DBA: WALGREENS #10088	5717 S. NC 41 HIGHWAY	WALLACE	NC	28466-9220	11/01/2011
CH045800	WALGREEN CO.	DBA: WALGREENS #13854	1103 N. BREAZEALE AVE.	MOUNT OLIVE	NC	28365	11/01/2011
CH045800	WALGREEN CO.	DBA: WALGREENS # 02222	2001 NEUSE BLVD	NEW BERN	NC	28560-3454	11/01/2011
CH045800	WALGREEN CO.	DBA: WALGREENS # 09462	601 COLLEGE ST	CLINTON	NC	28328-3501	11/01/2011
CH045800	WALGREEN CO.	DBA: WALGREENS # 09898	803 N JK POWELL	WHITEVILLE	NC	28472-2122	11/01/2011
CH045800	WALGREEN CO.	DBA: WALGREENS # 09434	424 N BRIGHTLEAF BLVD	SMITHFIELD	NC	27577-4674	11/01/2011
CH045800	WALGREEN CO.	DBA: WALGREENS # 07805	3296 VILLAGE DRIVE	FAYETTEVILLE	NC	28304	10/01/2014
CH045800	WALGREEN CO.	DBA: WALGREENS #02530	5098 SOUTHPORT SUPPLY RD. SE	SOUTHPORT	NC	28461	07/01/2017
CH045800	WALGREEN CO.	DBA: WALGREENS #12895	1501 W. CUMBERLAND ST.	DUNN	NC	28334	07/01/2019
CH045800	WALGREEN CO.	DBA: WALGREENS #11088	1500 E. BROAD AVE.	ROCKINGHAM	NC	28379	07/01/2019
CH045800	WALGREEN CO.	WALGREENS #16172	808 E 5TH ST	TABOR CITY	NC	28463	07/01/2019	03/24/2025
CH045800	WALGREEN CO.	DBA: WALGREENS #01051	4577 MAIN ST.	SHALLOTTE	NC	28470	07/01/2019	01/24/2024
CH045800	WALGREEN CO.	DBA: WALGREENS #01051	4577 MAIN ST.	SHALLOTTE	NC	28470	07/01/2019
CH045800	WALGREEN CO.	DBA: WALGREENS #11837	1138 SABBATH HOME RD SW	HOLDEN BEACH	NC	28462	07/01/2019
CH045800	WALGREEN CO.	DBA: WALGREENS #15151	6330 RAEFORD RD.	FAYETTEVILLE	NC	28304-2862	04/01/2024
CH045800	Walgreens #21420	Walgreens Central Fill #21420	8440 Times Dispatch Blvd Ste. 400	Mechanicsville	VA	23116	10/01/2023
CH045800	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013	06/30/2015
CH045800	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	07/01/2013	06/30/2015
CH045800	WALGREENS OF NORTH CAROLINA INC.	DBA: WALGREENS #16168	218 W MARTIN LUTHER KING JR HWY	ROSEBORO	NC	28382	01/01/2015
CH045800	WALGREENS OF NORTH CAROLINA INC.	DBA: WALGREENS #16166	RICHLAND PLZ, 9005 RICHLANDS HWY	RICHLANDS	NC	28574	04/01/2016
CH045800	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2024
CH045800	WALMART PHARMACY 10-6879	2820 GILLESPIE ST		FAYETTEVILLE	NC	28306	10/01/2022
CH045800	WALMART PHARMACY 10-7009	349 KINSTON HIGHWAY		RICHLANDS	NC	28574	04/01/2020
CH045800	WALMART PHARMACY 10-7340	1144 TOMMY'S RD		GOLDSBORO	NC	27534	10/01/2022
CH045800	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Parent, Brittany 340B Administrative Assistant Goshen Medical Center, Inc. 9107185200-110	Parent, Brittany 340B Administrative Assistant Goshen Medical Center, Inc. 9102670421-1348	3/24/2025 9:11 AM
Details	Last Recertification Date	Update	Recertification	1/31/2024 12:39:36 PM	3/10/2025 11:27:53 AM	3/10/2025 11:27 AM
Details	Entity Subname	Update	Recertification	GOSHEN MEDICAL CTR - BEULAVILLE	GOSHEN MEDICAL CENTER - BEULAVILLE	3/10/2025 11:27 AM
Contacts	Primary Contact	Update	Group Change Request	Raynor, Mollianne Kennedy PharmacyDirector Goshen Medical Center Inc. 9107185200	Parent, Brittany 340B Administrative Assistant Goshen Medical Center, Inc. 9107185200-110	10/7/2024 9:53 AM
Contacts	Primary Contact	Update	Change Request	Hall, Brooke Cottle Pharmacy Program Manager Goshen Medical Center, Inc. 9102670421-1139	Raynor, Mollianne Kennedy PharmacyDirector Goshen Medical Center Inc. 9107185200	4/12/2024 3:05 PM
Contacts	Authorizing Official	Update	Change Request	Raynor, Mollianne Kennedy PharmacyDirector Goshen Medical Center Inc. 9107185200	Barwick, Rhonda Deputy CEO Goshen Medical Center, Inc. 9102671942	4/12/2024 3:05 PM
Contacts	Primary Contact	Update	Profile Change Request	Cottle, Brooke Leigh Pharmacy Program Manager Goshen Medical Center, Inc. 9102670421-1139	Hall, Brooke Cottle Pharmacy Program Manager Goshen Medical Center, Inc. 9102670421-1139	2/2/2024 7:51 AM
Details	Last Recertification Date	Update	Recertification	1/30/2023 10:18:53 AM	1/31/2024 12:39:36 PM	1/31/2024 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1063043370 (NC)		1/19/2024 10:41 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/19/2024 10:41 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1558008664	1/19/2024 10:41 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	1/19/2024 10:41 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1063043370 (NC)		1/19/2024 10:41 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1558008664	1/19/2024 10:41 AM
Medicaid Billing	NPI: State	Insert	Change Request		NC	1/19/2024 10:41 AM
Addresses	Shipping Address	Update	Change Request	GMC Faison Pharmacy 444 SW Center St. Faison, NC 28341	GMC Pharmacy at Beulaville 119 Crossover Road Beulaville, NC 28518	5/1/2023 5:57 PM
Contacts	Authorizing Official	Update	Change Request	Smith, Robin Harrell Pharmacy Site Leader/Technician Goshen Medical Center, Inc. 9107185200	Raynor, Mollianne Kennedy PharmacyDirector Goshen Medical Center Inc. 9107185200	1/31/2023 9:26 AM
Details	Last Recertification Date	Update	Recertification	2/2/2022 5:59:28 PM	1/30/2023 10:18:53 AM	1/30/2023 10:18 AM
Contacts	Primary Contact	Update	Contract Pharmacy Registration	Cottle, Brooke Pharmacy Program Manager Goshen Medical Center, Inc. 9102670421-1139	Cottle, Brooke Leigh Pharmacy Program Manager Goshen Medical Center, Inc. 9102670421-1139	1/12/2023 9:02 AM
Contacts	Primary Contact	Update	Group Change Request	Maynor, Heather Lynette Director of Pharmacy Goshen Medical Center, Inc. 9107185200-1380	Cottle, Brooke Pharmacy Program Manager Goshen Medical Center, Inc. 9102670421-1139	10/11/2022 11:33 AM
Addresses	Shipping Address	Insert	Group Change Request		GMC Faison Pharmacy 444 SW Center St. Faison, NC 28341	2/9/2022 8:17 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	2/9/2022 8:17 AM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1063043370	2/9/2022 8:17 AM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		NC	2/9/2022 8:17 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1063043370	2/9/2022 8:17 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	2/9/2022 8:17 AM
Details	Last Recertification Date	Update	Recertification	2/4/2021 11:01:18 AM	2/2/2022 5:59:28 PM	2/2/2022 5:59 PM
Contacts	Primary Contact	Update	Profile Change Request	Maynor, Heather Lynette Pharmacy Manager Goshen Medical Center, Inc. 9107185200-1370	Maynor, Heather Lynette Director of Pharmacy Goshen Medical Center, Inc. 9107185200-1380	12/7/2021 5:31 PM
Contacts	Authorizing Official	Update	Change Request	BOUNDS, GREG CEO Goshen Medical Center, Inc. 9102671942-1117	Smith, Robin Harrell Pharmacy Site Leader/Technician Goshen Medical Center, Inc. 9107185200	12/7/2021 12:22 PM
Contacts	Authorizing Official	Update	AO Change Request	Koch, Erich Finance Director Goshen Medical Center, Inc. 9102671942-1127	BOUNDS, GREG CEO Goshen Medical Center, Inc. 9102671942-1117	8/24/2021 2:37 PM
Details	Last Recertification Date	Update	Recertification	2/4/2020 2:50:21 PM	2/4/2021 11:01:18 AM	2/4/2021 11:01 AM
Contacts	Primary Contact	Update	Change Request	Graham, Diane Chief Accounting Officer Goshen Medical Center, Inc. 9102672057-1358	Maynor, Heather Lynette Pharmacy Manager Goshen Medical Center, Inc. 9107185200-1370	10/27/2020 9:55 AM
Contacts	Authorizing Official	Update	Change Request	BOUNDS, GREG CEO Goshen Medical Center, Inc. 9102671942-1117	Koch, Erich Finance Director Goshen Medical Center, Inc. 9102671942-1127	10/27/2020 9:55 AM
Details	Last Recertification Date	Update	Recertification	2/8/2019 12:34:47 PM	2/4/2020 2:50:21 PM	2/4/2020 2:50 PM
Details	Last Recertification Date	Update	Recertification	2/12/2018 3:01:02 PM	2/8/2019 12:34:47 PM	2/8/2019 12:34 PM
Details	Last Recertification Date	Update	Recertification	2/11/2017 12:00:00 AM	2/12/2018 3:01:02 PM	2/12/2018 3:01 PM
Contacts	Authorizing Official	Update		BOUNDS, GREG CEO 9102671942-1117	BOUNDS, GREG CEO Goshen Medical Center, Inc. 9102671942-1117	1/18/2018 2:34 PM
Contacts	Primary Contact	Update		Graham, Diane Chief Accounting Officer 9102672057-1358	Graham, Diane Chief Accounting Officer Goshen Medical Center, Inc. 9102672057-1358	1/18/2018 2:04 PM
Contacts	Authorizing Official	Insert			BOUNDS, GREG CEO 9102671942-1117	7/12/2017 1:04 PM
Contacts	Primary Contact	Insert			Graham, Diane Chief Accounting Officer 9102672057-1358	5/15/2017 2:30 PM
Addresses	Main Address	Insert			119 CROSSOVER RD BEULAVILLE, NC 28518-8801	2/11/2017 4:09 PM
Details	Last Recertification Date	Update		2/20/2016 12:00:00 AM	2/11/2017 12:00:00 AM	2/11/2017 4:08 PM
Details	Last Recertification Date	Update		2/11/2015 12:00:00 AM	2/20/2016 12:00:00 AM	2/20/2016 12:38 PM
Details	Last Recertification Date	Update		3/22/2014 12:00:00 AM	2/11/2015 12:00:00 AM	2/11/2015 8:28 AM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/22/2014 12:00:00 AM	3/22/2014 8:41 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/15/2013 10:40 AM
Details	Entity Subname	Update		BEULAVILLE CLINIC	GOSHEN MEDICAL CTR - BEULAVILLE	3/15/2013 10:40 AM
Addresses	Billing Address	Insert			GOSHEN MEDICAL CENTER, INC. PO BOX 187 FAISON, NC 28341	8/12/2005 5:25 PM
Details	Last Recertification Date	Insert				8/12/2005 5:25 PM
Details	Grant Number	Insert			H80CS00181	8/12/2005 5:25 PM
Details	340B ID	Insert			CH04580G	8/12/2005 5:25 PM
Details	Is Authorizing Official EHB Data	Insert				8/12/2005 5:25 PM
Dates	Last Date That 340B Drugs Purchased	Insert				8/12/2005 5:25 PM
Details	Medicare Provider Number	Insert				8/12/2005 5:25 PM
Details	Entity Name	Insert			GOSHEN MEDICAL CENTER, INC.	8/12/2005 5:25 PM
Details	Program Code	Insert			CH	8/12/2005 5:25 PM
Details	Entity Subname	Insert			BEULAVILLE CLINIC	8/12/2005 5:25 PM
Dates	Participating Approval Date	Insert			9/10/2004 12:00:00 AM	8/12/2005 5:25 PM
Details	State	Insert			Active	8/12/2005 5:25 PM
Dates	Registration Date	Insert			10/1/2004 12:00:00 AM	8/12/2005 5:25 PM
Dates	Signed By Date	Insert				8/12/2005 5:25 PM
Dates	Start Date	Insert			10/1/2004 12:00:00 AM	8/12/2005 5:25 PM
Terminations	Termination Comments	Insert				8/12/2005 5:25 PM
Terminations	Termination Date	Insert				8/12/2005 5:25 PM
Terminations	Termination Effective Date	Insert				8/12/2005 5:25 PM
Terminations	Termination Reason	Insert				8/12/2005 5:25 PM
Details	Comments Public	Insert			NEW SITE 10/01/2004	8/12/2005 5:25 PM

340B Drug Pricing Program Database