Covered Entity Details

DSH340040 PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER (Active) - information as of 4/28/2025 1:46:52 AM

Main Details

Name

PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH340040

Medicare Provider Number

340040

Additional Details

Current Program Status

Active

Registration Date

10/26/2007

Participating Start Date

4/1/2003

Participating Approval Date

10/26/2007

Last Recertification Date

9/6/2024

Contacts

Authorizing Official

ECU Health Medical Center
Jay Briley, President
(252) 847-5014

Primary Contact

ECU Health
Natascha Aldrich, Pharmacy 340B Compliance Manager
(252) 847-3728

Addresses

Street Address

2100 STANTONSBURG RD
GREENVILLE, NC 27834

Billing Address

ECU Health Accounts Payable
PO Box 6028
Greenville, NC 27835-6028

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

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	1043218944,1285198283,1598272379,1780359687,1295458131	1043218944,1598272379,1285198283,1780359687,1295458131
AR		1043218944,1780359687
CA		1043218944,1780359687
CO		1043218944,1780359687
CT		1043218944,1780359687
DC		1043218944,1780359687
FL		1043218944,1780359687
GA		1043218944,1780359687
KY		1043218944,1780359687
MA		1043218944,1780359687
MD		1043218944,1780359687
MI		1043218944,1780359687
MO		1043218944,1780359687
MT		1043218944,1780359687
NJ		1043218944,1780359687
NV		1043218944,1780359687
NY		1043218944,1780359687
OH		1043218944,1780359687
PA		1043218944,1780359687
SC		1043218944,1780359687
TN		1043218944,1780359687
VA		1043218944,1780359687
WV		1043218944,1780359687
AL		1043218944,1780359687
IL		1043218944,1780359687
IN		1043218944,1780359687
LA		1043218944,1780359687
TX		1043218944,1780359687
DE		1043218944,1780359687
VT		1043218944,1780359687
NH		1043218944,1780359687
WA		1043218944,1780359687
AZ		1043218944,1780359687
ME		1043218944,1780359687
NM		1043218944,1780359687
NE		1043218944,1780359687
OK		1043218944,1780359687
UT		1043218944,1780359687
WI		1043218944,1780359687
MN		1043218944,1780359687

Shipping Addresses

Shipping Address 1

ECU Health Beaufort Hospital Campus
628 E 12th St
Washington, NC 27889-3409

Shipping Address 2

ECU Health Specialty Pharmacy
2100 Stantonsburg Road
Room 1CC-1105
Greenville, NC 27834-2818

Shipping Address 3

ECU Health Medical Center Outpatient Pharmacy
2100 Stantonsburg Rd, Room 1PH-160
Greenville, NC 27834

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/15/2021	10/01/2021		10/01/2021
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/15/2021	10/01/2021		10/01/2021
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/15/2021	10/01/2021		10/01/2021
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/15/2021	10/01/2021		10/01/2021
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/15/2021	10/01/2021		10/01/2021
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/15/2021	10/01/2021		10/01/2021
Contract Detail	ACRO PHARMACEUTICAL SERVICES LLC	ACRO PHARMACEUTICAL SERVICES LLC	313 HENDERSON DR	SHARON HILL	PA	19079	10/16/2017	01/01/2018	12/28/2018	12/28/2018
Contract Detail	ACRO PHARMACEUTICAL SERVICES, LLC	7891 STAGE HILLS BLVD STE 111		BARTLETT	TN	38133	10/16/2017	01/01/2018	12/28/2018	12/28/2018
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	10/16/2018	01/01/2019		01/01/2019
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	04/07/2020	07/01/2020		07/01/2020
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/19/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/19/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/19/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/19/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/19/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/19/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/19/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/19/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/19/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/19/2022	10/01/2022		10/01/2022
Contract Detail	COMMCARE PHARMACY-FTL, LLC	855 SW 78TH AVE STE C100		PLANTATION	FL	33324-3223	10/16/2017	01/01/2018	12/28/2018	12/28/2018
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/19/2022	10/01/2022		10/01/2022
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	10/17/2019	01/01/2020		01/01/2020
Contract Detail	DDP PHARMACY	DBA DRUGCO DISCOUNT PHARMACY	107 SMITH CHURCH RD	ROANOKE RAPIDS	NC	27870	01/12/2024	04/01/2024		04/01/2024
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	01/15/2019	04/01/2019	03/31/2021	01/18/2022
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	01/15/2019	04/01/2019	03/31/2021	07/19/2021
Contract Detail	DOGWOOD PHARMACY, INC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER ROAD SUITE K	GREENVILLE	SC	29607-6540	10/16/2018	01/01/2019		01/01/2019
Contract Detail	ECU PHARMACY	517 MOYE BLVD	ECU SCHOOL OF MEDICINE	GREENVILLE	NC	27834-2849	04/19/2023	07/01/2023		07/01/2023
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/15/2021	10/01/2021		10/01/2021
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/15/2021	10/01/2021		10/01/2021
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/15/2021	10/01/2021		10/01/2021
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/15/2021	10/01/2021		10/01/2021
Contract Detail	FAMILY PRACTICE PHARMACY	ECU BRODY SCHOOL OF MEDICINE	101 HEART DR	GREENVILLE	NC	27834-8982	04/19/2023	07/01/2023		07/01/2023
Contract Detail	GENOA HEALTHCARE LLC	835 JOHNS HOPKINS DR STE D		GREENVILLE	NC	27834	10/12/2023	01/01/2024		01/01/2024
Contract Detail	GENOA HEALTHCARE LLC	1200 N WEST AVE, STE 500		JACKSON	MI	49202	10/12/2023	01/01/2024		01/01/2024
Contract Detail	GENOA HEALTHCARE LLC	1209 S 1ST AVE		PHOENIX	AZ	85003	10/12/2023	01/01/2024		01/01/2024
Contract Detail	GENOA HEALTHCARE LLC	109 W BECKER DR		ROANOKE RAPIDS	NC	27870	10/12/2023	01/01/2024		01/01/2024
Contract Detail	GENOA HEALTHCARE LLC	170 PROSPERITY DRIVE	STE P	WINCHESTER	VA	22602	01/12/2024	04/01/2024		04/01/2024
Contract Detail	LEO JENKINS CANCER CTR PHCY	ECU BSOM	600 MOYE BLVD RM 240	GREENVILLE	NC	27834	04/19/2023	07/01/2023		07/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05420	770 WEST FIRE TOWER ROAD	WINTERVILLE	NC	28590	07/19/2022	10/01/2022		10/01/2022
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07324	420 W. MAIN ST.	MURFREESBORO	NC	27855	07/19/2022	10/01/2022		10/01/2022
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03895	4240 S. MAIN ST.	FARMVILLE	NC	27828	07/19/2022	10/01/2022		10/01/2022
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07021	2203 WAYNE MEMORIAL DR.	GOLDSBORO	NC	27534	07/19/2022	10/01/2022		10/01/2022
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07335	1601 FOREST HILLS ROAD	WILSON	NC	27893	07/19/2022	10/01/2022		10/01/2022
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04126	1020 JOHN SMALL AVENUE	WASHINGTON	NC	27889	07/19/2022	10/01/2022		10/01/2022
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07587	3116 EAST 10TH STREET	GREENVILLE	NC	27858	07/19/2022	10/01/2022		10/01/2022
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05568	801 NORTH BROAD ST	EDENTON	NC	27932	07/19/2022	10/01/2022		10/01/2022
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03867	3739 NASH ST. NW	WILSON	NC	27896	07/19/2022	10/01/2022		10/01/2022
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05567	1895 E. FIRETOWER RD	GREENVILLE	NC	27858	07/19/2022	10/01/2022		10/01/2022
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04988	101 WEST WASHINGTON ST	NASHVILLE	NC	27856	07/19/2022	10/01/2022		10/01/2022
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03385	704 S MEMORIAL DRIVE	GREENVILLE	NC	27834	07/19/2022	10/01/2022		10/01/2022
Contract Detail	OPTUM INFUSION SERVICES 553, LLC	6531 MERIDIEN DR	SUITE 113	RALEIGH	NC	27616	10/12/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	04/14/2022	04/15/2022		04/21/2022
Contract Detail	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	10/12/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	07/19/2021	10/01/2021		10/01/2021
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	10/12/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	07/19/2021	10/01/2021		10/01/2021
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	10/12/2023	01/01/2024		01/01/2024
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	10/17/2019	01/01/2020	10/01/2022	10/14/2022
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/19/2022	10/01/2022		10/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/19/2022	10/01/2022		10/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/19/2022	10/01/2022		10/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/19/2022	10/01/2022		10/01/2022
Contract Detail	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	10/16/2018	01/01/2019		01/01/2019
Contract Detail	REALO DISCOUNT DRUG	1302 W VERNON AVE		KINSTON	NC	28504-3528	07/17/2018	10/01/2018		10/01/2018
Contract Detail	REALO DISCOUNT DRUG	300 N QUEEN ST		KINSTON	NC	28501	07/17/2018	10/01/2018		10/01/2018
Contract Detail	REALO DISCOUNT DRUG STORES OF EASTERN NC	DBA REALO DISCOUNT DRUGS	103 CROSSOVER RD	BEULAVILLE	NC	28518	01/12/2024	04/01/2024		04/01/2024
Contract Detail	REALO DISCOUNT DRUG STORES OF EASTERN NC	D/B/A REALO DISCOUNT DRUGS	1301 COMMERCE DR	NEW BERN	NC	28562	01/12/2024	04/01/2024		04/01/2024
Contract Detail	REALO DISCOUNT DRUG STORES OF EASTERN NO	CAROLINA INC	1913 E FIRE TOWER RD STE K D/B/A REALO DISCOUNT DRUGS	GREENVILLE	NC	27858-4127	07/17/2018	10/01/2018		10/01/2018
Contract Detail	REALO DISCOUNT DRUG STORES OF EASTERN NO	D B A REALO EXTENDED CARE PHARMACY	2500 TRENT RD STE 40 TRENT VILLAGE SHOP CTN	NEW BERN	NC	28562-2008	01/12/2024	04/01/2024		04/01/2024
Contract Detail	REALO DISCOUNT DRUG STORES OF EASTERN NO	CAROLINA INC	D/B/A REALO DISCOUNT DRUGS 5655 S NC 41 HWY	WALLACE	NC	28466	01/12/2024	04/01/2024		04/01/2024
Contract Detail	REALO DISCOUNT DRUG STORES OF ENC, INC	3724 RALEIGH ROAD PKWY W	STE A	WILSON	NC	27896	01/12/2024	04/01/2024		04/01/2024
Contract Detail	REALO DISCOUNT DRUG STORES OF ENC, INC	3900 NASH ST N		WILSON	NC	27896-1122	01/12/2024	04/01/2024		04/01/2024
Contract Detail	REALO DISCOUNT DRUG STORES OF GREENE CO.	104 PARKWOOD DR		SNOW HILL	NC	28580-1336	07/17/2018	10/01/2018		10/01/2018
Contract Detail	REALO SPECIALTY CARE PHARMACY, INC	860 AVIATION PKWY STE 1400		MORRISVILLE	NC	27560	10/16/2018	01/01/2019	02/17/2022	04/14/2022
Contract Detail	REALO SPECIALTY CARE PHARMACY, INC	860 AVIATION PKWY STE 1400		MORRISVILLE	NC	27560	10/14/2022	01/01/2023		01/01/2023
Contract Detail	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	10/16/2018	01/01/2019		01/01/2019
Contract Detail	UHS EMPLOYEE PHARMACY	D/B/A ECU HEALTH EMPLOYEE PHARMACY	2000 VENTURE TOWER DR P O BOX 6028	GREENVILLE	NC	27834	04/19/2023	07/01/2023		07/01/2023
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/14/2021	04/01/2021		04/01/2021
Contract Detail	WAL-MART PHARMACY 10-1354	570 PAMLICO PLAZA		WASHINGTON	NC	27889	10/16/2018	01/01/2019		01/01/2019
Contract Detail	WAL-MART PHARMACY 10-1379	210 GREENVILLE BLVD., S.W.		GREENVILLE	NC	27834	04/20/2018	07/01/2018		04/20/2018
Contract Detail	WAL-MART PHARMACY 10-1641	1529 WASHINGTON ST		WILLIAMSTON	NC	27892	04/16/2018	07/01/2018		04/16/2018
Contract Detail	WAL-MART PHARMACY 10-1661	4101 W. VERNON AVE		KINSTON	NC	28504-9672	04/20/2018	07/01/2018	11/01/2020	01/14/2021
Contract Detail	WAL-MART PHARMACY 10-1950	2150 US 13 SOUTH		AHOSKIE	NC	27910	04/20/2018	07/01/2018		04/20/2018
Contract Detail	WAL-MART PHARMACY 10-2730	110 RIVER OAKS DRIVE		TARBORO	NC	27886	04/20/2018	07/01/2018		04/20/2018
Contract Detail	WAL-MART PHARMACY 10-5851	4600 E. 10TH STREET		GREENVILLE	NC	27858	04/20/2018	07/01/2018		04/20/2018
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/14/2021	04/01/2021		04/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 9988	627 EAST 12TH STREET	WASHINGTON	NC	27889-3408	10/17/2019	01/01/2020		01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06926	3001 NORTH CAROLINA HWY 42 W	WILSON	NC	27893	10/17/2019	01/01/2020		01/01/2020
Contract Detail	WALGREEN CO.	WALGREENS #21340	915 SE SECOND ST	SNOW HILL	NC	28580	10/17/2019	01/01/2020		01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06616	2105 E FIRE TOWER ROAD	GREENVILLE	NC	27858	10/17/2019	01/01/2020		01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07715	103 GREENVILLE BLVD SE	GREENVILLE	NC	27858-5707	10/17/2019	01/01/2020	01/29/2025	03/05/2025
Contract Detail	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #16313	2816 ERWIN ROAD SUITE 105	DURHAM	NC	27705	10/17/2019	01/01/2020		01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12046	4211 WINTERVILLE PARKWAY	WINTERVILLE	NC	28590	10/17/2019	01/01/2020		01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06579	671 S MEMORIAL DRIVE	GREENVILLE	NC	27834	10/17/2019	01/01/2020		01/01/2020
Contract Detail	WALGREEN CO.	WALGREENS #16154	140 NC HWY 102 WEST	AYDEN	NC	28513	10/17/2019	01/01/2020		01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02453	3101 E 10TH STREET	GREENVILLE	NC	27858	10/17/2019	01/01/2020		01/01/2020
Contract Detail	WALGREEN CO.	WALGREENS #16130	11 US HWY 64 EAST	PLYMOUTH	NC	27962	10/17/2019	01/01/2020		01/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09897	2201 N HERRITAGE STREET	KINSTON	NC	28501	10/17/2019	01/01/2020		01/01/2020
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16405	1500 E 3RD ST STE A	CHARLOTTE	NC	28204	10/17/2019	01/01/2020		01/01/2020
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21181	123 SUNNYBROOK RD, STE 150	RALEIGH	NC	27610	07/19/2022	10/01/2022		10/01/2022
Contract Detail	WALGREEN CO.	WALGREENS #17018	5016 OLD TAR RD	WINTERVILLE	NC	28590	01/12/2024	04/01/2024		04/01/2024
Contract Detail	WALGREEN CO.	WALGREENS #17331	1560 US HIGHWAY 17	WILLIAMSTON	NC	27892	10/15/2024	01/01/2025		01/01/2025
Contract Detail	Walgreens #21420	Walgreens Central Fill #21420	8440 Times Dispatch Blvd Ste. 400	Mechanicsville	VA	23116	07/25/2023	10/01/2023		10/01/2023
Contract Detail	WALGREENS OF NORTH CAROLINA INC.	DBA: WALGREENS #16130	11 US HWY 64 EAST	PLYMOUTH	NC	27962	10/21/2021	01/01/2022	01/01/2022	04/14/2022
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	10/17/2019	01/01/2020		01/01/2020
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	10/17/2019	01/01/2020		01/01/2020
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	10/17/2019	01/01/2020		01/01/2020
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	10/17/2019	01/01/2020	09/29/2021	10/21/2021
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	05/05/2023	07/01/2023		07/01/2023
Contract Detail	WALMART PHARMACY 10-7222	2830 GATEWAY DRIVE		GREENVILLE	NC	27834	04/20/2018	07/01/2018		04/20/2018
Contract Detail	WALMART PHARMACY 10-7235	3801 S MEMORIAL DRIVE		WINTERVILLE	NC	28590	04/16/2018	07/01/2018		04/16/2018
Contract Detail	WALMART PHARMACY 10-7337	1826 E. ARLINGTON BLVD		GREENVILLE	NC	27858	04/16/2018	07/01/2018		04/16/2018
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/12/2024	04/01/2024		04/01/2024
Contract Detail	WH PHARMACY 1, LLC.	DBA DRUGCO DISCOUNT PHARMACY - TARBORO	1507 N MAIN ST	TARBORO	NC	27886	01/12/2024	04/01/2024		04/01/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH340040A	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	Pain Management Anesthesiology Section	2010 W. Arlington Blvd.	Greenville	NC	Active
DSH340040AA	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Pulmonary Rehab	628 E 12TH ST	Washington	NC	Active
DSH340040AB	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Respiratory Care	628 E 12TH ST	Washington	NC	Active
DSH340040AC	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Sleep Center	628 E 12TH ST	Washington	NC	Active
DSH340040AD	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Post Anesthesia Care Unit	628 E 12TH ST	Washington	NC	Active
DSH340040AE	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Labor and Delivery	628 E 12TH ST	Washington	NC	Active
DSH340040AF	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Laboratory	628 E 12TH ST	Washington	NC	Active
DSH340040AG	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Medical Center - Gastroenterology (Testing) - GI Motility and Pulmonary Function Testing	2264 Stantonsburg Road	Greenville	NC	Active
DSH340040AH	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Infusion - Kinston - Kinston Infusion Clinic	2100 Stantonsburg Road	Greenville	NC	Active
DSH340040B	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	Rehab-General Outpatient Outreach	2610 Stantonsburg Road, Suite A	Greenville	NC	Active
DSH340040C	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	Med Direct	2380 Arlington Blvd.	Greenville	NC	Terminated
DSH340040D	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Wound Healing Center - Greenville - Wound Care	3900 East 10th St	Greenville	NC	Active
DSH340040E	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Radiology-Ultrasound	628 E 12TH ST	Washington	NC	Active
DSH340040F	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Radiology-Vascular/Intervention	628 E 12TH ST	Washington	NC	Active
DSH340040G	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Radiology-CT Scanning	628 E 12TH ST	Washington	NC	Active
DSH340040H	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Radiology-MRI	628 E 12TH ST	Washington	NC	Active
DSH340040J	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Speech Language Pathology	628 E 12TH ST	Washington	NC	Active
DSH340040K	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU HEALTH PATIENT TESTING CENTER - Patient Testing-ECUH Medical Center	626 MEDICAL DR	GREENVILLE	NC	Active
DSH340040L	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Sleep Center - Sleep Center-ECUH Medical Center	650 Medical Drive	Greenville	NC	Active
DSH340040M	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Operating Room	628 E 12TH ST	Washington	NC	Active
DSH340040N	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Radiology-Nuclear Medicine	628 E 12TH ST	Washington	NC	Active
DSH340040P	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Physical Therapy	628 E 12TH ST	Washington	NC	Active
DSH340040Q	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Occupational Therapy	628 E 12TH ST	Washington	NC	Active
DSH340040R	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Echocardiology	628 E 12TH ST	Washington	NC	Active
DSH340040S	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	dba ECU Health Beaufort Hospital - Anesthesiology-ECUH Beaufort Campus	628 E 12TH ST	Washington	NC	Active
DSH340040T	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - EKG	628 E 12TH ST	Washington	NC	Active
DSH340040U	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Operating Room (BFT)	628 E 12TH ST	Washington	NC	Active
DSH340040V	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - CVP Rehab	628 E 12TH ST	Washington	NC	Active
DSH340040W	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Radiation Oncology	628 E 12TH ST	Washington	NC	Active
DSH340040X	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Emergency Department	628 E 12TH ST	Washington	NC	Active
DSH340040Y	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	MARION L SHEPARD CANCER CENTER - ECU Health Beaufort Hospital Oncology	1209 BROWN ST	WASHINGTON	NC	Active
DSH340040Z	Child	DSH	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	ECU Health Beaufort Hospital - Radiology-Diagnostic	628 E 12TH ST	Washington	NC	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Update	Change Request	ECU Health Specialty Pharmacy 2100 Statonsburg Road Room 1CC-1105 Greenville, NC 27834-2818	ECU Health Specialty Pharmacy 2100 Stantonsburg Road Room 1CC-1105 Greenville, NC 27834-2818	1/15/2025 10:26 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1043218944	12/13/2024 10:07 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	12/13/2024 10:07 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1780359687	12/13/2024 10:07 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		MN	12/13/2024 10:07 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/6/2024 12:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/6/2024 12:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1780359687	9/6/2024 12:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/6/2024 12:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/6/2024 12:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/6/2024 12:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1780359687	9/6/2024 12:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/6/2024 12:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/6/2024 12:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/6/2024 12:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1780359687	9/6/2024 12:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/6/2024 12:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/6/2024 12:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/6/2024 12:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1780359687	9/6/2024 12:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/6/2024 12:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/6/2024 12:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/6/2024 12:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1780359687	9/6/2024 12:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/6/2024 12:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/6/2024 12:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		UT	9/6/2024 12:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1780359687	9/6/2024 12:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		UT	9/6/2024 12:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/6/2024 12:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/6/2024 12:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1780359687	9/6/2024 12:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/6/2024 12:40 PM
Details	Last Recertification Date	Update	Recertification	8/30/2023 3:53:46 PM	9/6/2024 12:40:26 PM	9/6/2024 12:40 PM
Contacts	Authorizing Official	Update	Change Request	Floyd, Brian President ECU Health 2528475949	Briley, Jay President ECU Health Medical Center 2528475014	7/30/2024 12:23 PM
Addresses	Shipping Address	Delete	Recertification	Vidant Cancer Center Pharmacy 2100 Statonsburg Road Room 1CC-1105 Greenville, NC 27834-2818		8/30/2023 3:53 PM
Addresses	Shipping Address	Delete	Recertification	Vidant Medical Center Outpatient Pharmacy 2100 Stantonsburg Rd, Room 1PH-160 Greenville, NC 27834		8/30/2023 3:53 PM
Addresses	Shipping Address	Insert	Recertification		ECU Health Specialty Pharmacy 2100 Statonsburg Road Room 1CC-1105 Greenville, NC 27834-2818	8/30/2023 3:53 PM
Addresses	Shipping Address	Insert	Recertification		ECU Health Medical Center Outpatient Pharmacy 2100 Stantonsburg Rd, Room 1PH-160 Greenville, NC 27834	8/30/2023 3:53 PM
Details	Last Recertification Date	Update	Recertification	9/2/2022 12:47:11 PM	8/30/2023 3:53:46 PM	8/30/2023 3:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	6/14/2023 3:04 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1295458131	6/14/2023 3:04 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		NC	6/14/2023 3:04 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1295458131	6/14/2023 3:04 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	6/14/2023 3:04 PM
Contacts	Primary Contact	Update	Change Request	Rowland, Natascha Pharmacy 340B Compliance Manager ECU Health Medical Center 2528473728	Aldrich, Natascha Pharmacy 340B Compliance Manager ECU Health 2528473728	2/27/2023 8:42 AM
Contacts	Authorizing Official	Update	Change Request	Floyd, Brian PRESIDENT ECU Health 2528475949	Floyd, Brian President ECU Health 2528475949	2/27/2023 8:42 AM
Details	Last Recertification Date	Update	Recertification	8/31/2021 4:31:51 PM	9/2/2022 12:47:11 PM	9/2/2022 12:47 PM
Addresses	Billing Address	Update	Change Request	Vidant Health Accounts Payable PO Box 6028 Greenville, NC 27835-6028	ECU Health Accounts Payable PO Box 6028 Greenville, NC 27835-6028	6/8/2022 12:46 PM
Addresses	Shipping Address	Update	Change Request	Vidant Beaufort Campus 628 E 12th St Washington, NC 27889-3409	ECU Health Beaufort Hospital Campus 628 E 12th St Washington, NC 27889-3409	6/8/2022 12:46 PM
Details	Entity Name	Update	Change Request	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a VIDANT MEDICAL CENTER	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a ECU HEALTH MEDICAL CENTER	6/8/2022 12:46 PM
Contacts	Primary Contact	Update	Profile Change Request	Rowland, Natascha Pharmacy 340B Compliance Manager Vidant Medical Center 2528473728	Rowland, Natascha Pharmacy 340B Compliance Manager ECU Health Medical Center 2528473728	6/8/2022 7:34 AM
Contacts	Authorizing Official	Update	Profile Change Request	Floyd, Brian PRESIDENT Vidant Health 2528475949	Floyd, Brian PRESIDENT ECU Health 2528475949	6/6/2022 4:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/14/2021 4:26 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1043218944	12/14/2021 4:26 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	12/14/2021 4:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/14/2021 4:26 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1285198283	12/14/2021 4:26 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	12/14/2021 4:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/14/2021 4:26 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1598272379	12/14/2021 4:26 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	12/14/2021 4:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/14/2021 4:26 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1780359687	12/14/2021 4:26 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	12/14/2021 4:26 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1043218944	12/14/2021 4:26 PM
Medicaid Billing	NPI: State	Insert	Change Request		NH	12/14/2021 4:26 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	12/14/2021 4:26 PM
Medicaid Billing	NPI: State	Insert	Change Request		NH	12/14/2021 4:26 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1043218944	12/14/2021 4:26 PM
Medicaid Billing	NPI: State	Insert	Change Request		WA	12/14/2021 4:26 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	12/14/2021 4:26 PM
Medicaid Billing	NPI: State	Insert	Change Request		WA	12/14/2021 4:26 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		NC	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		AR	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		CA	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		CO	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		CT	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		DC	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		FL	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		GA	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		KY	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		MA	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		MI	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		MO	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		MT	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		NJ	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		NV	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		NY	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		OH	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		PA	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		SC	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		TN	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		VA	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		WV	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		AL	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		IL	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		IN	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		LA	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		TX	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		DE	10/21/2021 10:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780359687	10/21/2021 10:38 AM
Medicaid Billing	NPI: State	Insert	Change Request		VT	10/21/2021 10:38 AM
Details	Last Recertification Date	Update	Recertification	9/4/2020 8:04:26 AM	8/31/2021 4:31:51 PM	8/31/2021 4:31 PM
Addresses	Shipping Address	Insert	Change Request		Vidant Beaufort Campus 628 E 12th St Washington, NC 27889-3409	8/12/2021 2:58 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1043218944	6/16/2021 9:36 AM
Medicaid Billing	NPI: State	Insert	Change Request		DE	6/16/2021 9:36 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1043218944	6/16/2021 9:36 AM
Medicaid Billing	NPI: State	Insert	Change Request		VT	6/16/2021 9:36 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1043218944	9/15/2020 7:59 AM
Medicaid Billing	NPI: State	Insert	Change Request		AL	9/15/2020 7:59 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1043218944	9/15/2020 7:59 AM
Medicaid Billing	NPI: State	Insert	Change Request		IL	9/15/2020 7:59 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1043218944	9/15/2020 7:59 AM
Medicaid Billing	NPI: State	Insert	Change Request		IN	9/15/2020 7:59 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1043218944	9/15/2020 7:59 AM
Medicaid Billing	NPI: State	Insert	Change Request		LA	9/15/2020 7:59 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1043218944	9/15/2020 7:59 AM
Medicaid Billing	NPI: State	Insert	Change Request		TX	9/15/2020 7:59 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	340040 (NC)		9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Update	Recertification		NC	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		MT	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		NV	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/4/2020 8:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043218944	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Update	Recertification		NC	9/4/2020 8:04 AM
Medicaid Billing	NPI: State	Update	Recertification		NC	9/4/2020 8:04 AM
Details	Last Recertification Date	Update	Recertification	9/9/2019 8:37:05 AM	9/4/2020 8:04:26 AM	9/4/2020 8:04 AM
Addresses	Shipping Address	Delete	Change Request	Vidant Medical Center Outpatient Pharmacy 2100 Stantonsburg Rd, Room 1PC-101 Greenville, NC 27834		11/19/2019 9:31 AM
Addresses	Shipping Address	Insert	Change Request		Vidant Medical Center Outpatient Pharmacy 2100 Stantonsburg Rd, Room 1PH-160 Greenville, NC 27834	11/19/2019 9:31 AM
Details	Last Recertification Date	Update	Recertification	8/27/2018 1:35:24 PM	9/9/2019 8:37:05 AM	9/9/2019 8:37 AM
Addresses	Shipping Address	Insert	Change Request		Vidant Medical Center Outpatient Pharmacy 2100 Stantonsburg Rd, Room 1PC-101 Greenville, NC 27834	3/13/2019 7:24 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1285198283	3/13/2019 7:24 AM
Contacts	Primary Contact	Update	Change Request	KOSKA, STEPHEN ASSISTANT DIRECTOR OF PHARMACY Vidant Health 2528474261	Rowland, Natascha Pharmacy 340B Compliance Manager Vidant Medical Center 2528473728	3/13/2019 7:24 AM
Details	Last Recertification Date	Update	Recertification	11/8/2017 1:47:11 PM	8/27/2018 1:35:24 PM	8/27/2018 1:35 PM
Addresses	Shipping Address	Delete	Change Request	Vidant Cancer Center Pharmacy 2100 Statonsburg Road Room 1CC-1105 Greenville, NC 27835-6028		3/7/2018 8:37 AM
Addresses	Shipping Address	Insert	Change Request		Vidant Cancer Center Pharmacy 2100 Statonsburg Road Room 1CC-1105 Greenville, NC 27834-2818	3/7/2018 8:37 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1598272379	3/7/2018 8:37 AM
Addresses	Shipping Address	Insert	Change Request		Vidant Cancer Center Pharmacy 2100 Statonsburg Road Room 1CC-1105 Greenville, NC 27835-6028	1/17/2018 7:38 AM
Addresses	Billing Address	Insert	Recertification		Vidant Health Accounts Payable PO Box 6028 Greenville, NC 27835-6028	11/8/2017 1:47 PM
Details	Last Recertification Date	Update	Recertification	8/18/2016 12:00:00 AM	11/8/2017 1:47:11 PM	11/8/2017 1:47 PM
Contacts	Authorizing Official	Update		Floyd, Brian PRESIDENT 2528475949	Floyd, Brian PRESIDENT Vidant Health 2528475949	10/16/2017 12:54 PM
Contacts	Primary Contact	Update		KOSKA, STEPHEN ASSISTANT DIRECTOR OF PHARMACY 2528474261	KOSKA, STEPHEN ASSISTANT DIRECTOR OF PHARMACY Vidant Health 2528474261	10/13/2017 11:38 AM
Contacts	Primary Contact	Update		Paoloni, Barry Pharmacy Business Coordinator 2528471016	KOSKA, STEPHEN ASSISTANT DIRECTOR OF PHARMACY 2528474261	8/18/2016 10:50 AM
Addresses	Main Address	Insert			2100 STANTONSBURG RD GREENVILLE, NC 27834	8/18/2016 8:19 AM
Contacts	Authorizing Official	Insert			Floyd, Brian PRESIDENT 2528475949	8/18/2016 8:19 AM
Details	Last Recertification Date	Update		8/14/2015 12:00:00 AM	8/18/2016 12:00:00 AM	8/18/2016 8:19 AM
Details	Last Recertification Date	Update		9/9/2014 12:00:00 AM	8/14/2015 12:00:00 AM	8/14/2015 2:39 PM
Details	Last Recertification Date	Update		9/13/2013 12:00:00 AM	9/9/2014 12:00:00 AM	9/9/2014 11:36 AM
Details	Entity Name	Update		PITT COUNTY MEMORIAL HOSPITAL	PITT COUNTY MEMORIAL HOSPITAL, INCORPORATED d/b/a VIDANT MEDICAL CENTER	1/24/2014 4:34 PM
Contacts	Primary Contact	Insert			Paoloni, Barry Pharmacy Business Coordinator 2528471016	9/13/2013 12:04 PM
Medicaid Billing	Medicaid: Number	Update		3400040	340040	9/13/2013 12:04 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/13/2013 12:00:00 AM	9/13/2013 12:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	5/22/2012 12:43 PM
Medicaid Billing	Medicaid: Number	Insert			3400040	5/22/2012 12:43 PM
Medicaid Billing	Medicaid: State	Insert			NC	5/22/2012 12:43 PM
Medicaid Billing	NPI: Number	Insert			1043218944	5/22/2012 12:43 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/22/2012 12:43 PM
Details	Last Recertification Date	Insert				9/16/2010 4:49 PM
Details	Grant Number	Insert				9/16/2010 4:49 PM
Details	340B ID	Insert			DSH340040	9/16/2010 4:49 PM
Details	Is Authorizing Official EHB Data	Insert				9/16/2010 4:49 PM
Dates	Last Date That 340B Drugs Purchased	Insert				9/16/2010 4:49 PM
Details	Medicare Provider Number	Insert			340040	9/16/2010 4:49 PM
Details	Entity Name	Insert			PITT COUNTY MEMORIAL HOSPITAL	9/16/2010 4:49 PM
Details	Program Code	Insert			DSH	9/16/2010 4:49 PM
Details	Entity Subname	Insert				9/16/2010 4:49 PM
Dates	Participating Approval Date	Insert			10/26/2007 12:00:00 AM	9/16/2010 4:49 PM
Details	State	Insert			Active	9/16/2010 4:49 PM
Dates	Registration Date	Insert			10/26/2007 12:00:00 AM	9/16/2010 4:49 PM
Dates	Signed By Date	Insert				9/16/2010 4:49 PM
Dates	Start Date	Insert			4/1/2003 12:00:00 AM	9/16/2010 4:49 PM
Terminations	Termination Comments	Insert				9/16/2010 4:49 PM
Terminations	Termination Date	Insert				9/16/2010 4:49 PM
Terminations	Termination Effective Date	Insert				9/16/2010 4:49 PM
Terminations	Termination Reason	Insert				9/16/2010 4:49 PM