| Addresses | Shipping Address | Update | Change Request | Scotland Pharmacy - Laurinburg
700 PROGRESS PL
Laurinburg, NC 28352 | Scotland Pharmacy - Laurinburg
101 Plaza Rd
Laurinburg, NC 28352 | 2/3/2025 7:40 AM |
| Details | Last Recertification Date | Update | Recertification | 8/22/2023 3:47:27 PM | 8/22/2024 7:40:31 AM | 8/22/2024 7:40 AM |
| Details | Last Recertification Date | Update | Recertification | 8/31/2022 3:02:51 PM | 8/22/2023 3:47:27 PM | 8/22/2023 3:47 PM |
| Addresses | Shipping Address | Delete | Recertification | Pembroke Family Practice Center
410 D S Jones St.
Pembroke, NC 28372 | | 8/31/2022 3:02 PM |
| Addresses | Shipping Address | Delete | Recertification | Harris Family Practice
700 PROGRESS PL
Laurinburg, NC 28352 | | 8/31/2022 3:02 PM |
| Addresses | Shipping Address | Delete | Recertification | Marlboro Family Practice and Urgent Care
957 Cheraw St
Bennettsville, SC 29512 | | 8/31/2022 3:02 PM |
| Addresses | Shipping Address | Insert | Recertification | | Scotland Pharmacy - Pembroke
412 S Jones St.
Pembroke, NC 28372 | 8/31/2022 3:02 PM |
| Addresses | Shipping Address | Insert | Recertification | | Scotland Pharmacy - Laurinburg
700 PROGRESS PL
Laurinburg, NC 28352 | 8/31/2022 3:02 PM |
| Addresses | Shipping Address | Insert | Recertification | | Scotland Pharmacy - Bennettsville
957 Cheraw St
Bennettsville, SC 29512 | 8/31/2022 3:02 PM |
| Details | Last Recertification Date | Update | Recertification | 8/19/2021 12:06:52 PM | 8/31/2022 3:02:51 PM | 8/31/2022 3:02 PM |
| Details | Last Recertification Date | Update | Recertification | 8/21/2020 7:19:29 AM | 8/19/2021 12:06:52 PM | 8/19/2021 12:06 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Pope, David L
Senior Vice President, Operations
Scotland Health Care System
9102917502 | Holt, Beatrice M
Senior Vice President Patient Care Services
Scotland Memorial Hospital
9102917531 | 8/18/2021 9:58 AM |
| Contacts | Primary Contact | Update | Change Request | Chu, Paul
Director, Pharmacy Services
Scotland Memorial Hospital
9102917789 | Graham, Claire W
Director of Pharmacy
Scotland Health Care System
9102917782 | 1/29/2021 12:44 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1912428616 ( ) | | 8/21/2020 7:19 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1770123887 ( ) | | 8/21/2020 7:19 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1457345597 | 8/21/2020 7:19 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | NC | 8/21/2020 7:19 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1770123887 | 8/21/2020 7:19 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | NC | 8/21/2020 7:19 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1912428616 | 8/21/2020 7:19 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | NC | 8/21/2020 7:19 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1457345597 ( ) | | 8/21/2020 7:19 AM |
| Details | Last Recertification Date | Update | Recertification | 8/22/2019 5:37:56 AM | 8/21/2020 7:19:29 AM | 8/21/2020 7:19 AM |
| Addresses | Shipping Address | Insert | Change Request | | Marlboro Family Practice and Urgent Care
957 Cheraw St
Bennettsville, SC 29512 | 8/14/2020 11:20 AM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1295359818 | 8/14/2020 11:20 AM |
| Medicaid Billing | NPI: State | Insert | Change Request | | SC | 8/14/2020 11:20 AM |
| Addresses | Shipping Address | Delete | Change Request | Harris Family Practice
700 A Progress Place
Laurinburg, NC 28352 | | 6/29/2020 12:41 PM |
| Addresses | Shipping Address | Insert | Change Request | | Harris Family Practice
700 PROGRESS PL
Laurinburg, NC 28352 | 6/29/2020 12:41 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1770123887 | 6/29/2020 12:41 PM |
| Addresses | Shipping Address | Insert | Change Request | | Scotland Memorial Hospital
500 Lauchwood Drive
Laurinburg, NC 28352 | 3/4/2020 8:47 AM |
| Addresses | Shipping Address | Insert | Change Request | | Pembroke Family Practice Center
410 D S Jones St.
Pembroke, NC 28372 | 3/4/2020 8:47 AM |
| Addresses | Shipping Address | Insert | Change Request | | Harris Family Practice
700 A Progress Place
Laurinburg, NC 28352 | 3/4/2020 8:47 AM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1912428616 | 10/3/2019 8:00 AM |
| Addresses | Shipping Address | Delete | Recertification | Scotland Pharmacy - Pembroke
410-D South Jones Street
Pembroke, NC 28372 | | 8/22/2019 5:37 AM |
| Details | Last Recertification Date | Update | Recertification | 8/22/2018 2:22:30 PM | 8/22/2019 5:37:56 AM | 8/22/2019 5:37 AM |
| Contacts | Authorizing Official | Update | Change Request | Davis, Cheryl
Chief Medical Officer
Scotland Memorial Hospital
9102917532 | Pope, David L
Senior Vice President, Operations
Scotland Health Care System
9102917502 | 3/18/2019 8:11 AM |
| Addresses | Shipping Address | Insert | Change Request | | Scotland Pharmacy - Pembroke
410-D South Jones Street
Pembroke, NC 28372 | 12/10/2018 8:12 AM |
| Contacts | Authorizing Official | Update | Change Request | Phillips, Pat
Senior Vice President of Operations
Scotland Memorial Hospital
9102917502 | Davis, Cheryl
Chief Medical Officer
Scotland Memorial Hospital
9102917532 | 10/16/2018 9:45 AM |
| Details | Last Recertification Date | Update | Recertification | 11/20/2017 9:15:26 AM | 8/22/2018 2:22:30 PM | 8/22/2018 2:22 PM |
| Details | Last Recertification Date | Update | Recertification | 8/15/2016 12:00:00 AM | 11/20/2017 9:15:26 AM | 11/20/2017 9:15 AM |
| Contacts | Authorizing Official | Insert | Change Request | | Phillips, Pat
Senior Vice President of Operations
Scotland Memorial Hospital
9102917502 | 9/28/2017 1:35 PM |
| Contacts | Primary Contact | Update | | Chu, Paul
Director, Pharmacy Services
9102917789 | Chu, Paul
Director, Pharmacy Services
Scotland Memorial Hospital
9102917789 | 9/25/2017 11:23 AM |
| Addresses | Main Address | Insert | | |
500 LAUCHWOOD DRIVE
LAURINBURG, NC 28352 | 8/15/2016 9:44 AM |
| Contacts | Primary Contact | Update | | Strickland, Ronnie
Pharmacy Director
9102917790 | Chu, Paul
Director, Pharmacy Services
9102917789 | 8/15/2016 9:44 AM |
| Details | Last Recertification Date | Update | | 8/17/2015 12:00:00 AM | 8/15/2016 12:00:00 AM | 8/15/2016 9:43 AM |
| Medicaid Billing | Medicaid: Is Primary | Update | | True | False | 8/17/2015 9:52 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1457345597 | 8/17/2015 9:52 AM |
| Details | Last Recertification Date | Update | | 8/7/2014 12:00:00 AM | 8/17/2015 12:00:00 AM | 8/17/2015 9:52 AM |
| Details | Last Recertification Date | Update | | 8/27/2013 12:00:00 AM | 8/7/2014 12:00:00 AM | 8/7/2014 2:19 PM |
| Details | Last Recertification Date | Update | | 7/1/2012 12:00:00 AM | 8/27/2013 12:00:00 AM | 8/27/2013 11:12 AM |
| Contacts | Primary Contact | Insert | | | Strickland, Ronnie
Pharmacy Director
9102917790 | 5/22/2012 12:41 PM |
| Details | Last Recertification Date | Update | | | 7/1/2012 12:00:00 AM | 5/22/2012 12:41 PM |
| Dates | Participating Approval Date | Update | | 4/22/2008 10:44:07 AM | 4/22/2008 12:00:00 AM | 3/22/2012 4:16 PM |
| Details | Last Recertification Date | Insert | | | | 4/22/2008 10:47 AM |
| Details | Grant Number | Insert | | | | 4/22/2008 10:47 AM |
| Details | 340B ID | Insert | | | DSH340008 | 4/22/2008 10:47 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 4/22/2008 10:47 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/22/2008 10:47 AM |
| Details | Medicare Provider Number | Insert | | | 340008 | 4/22/2008 10:47 AM |
| Details | Entity Name | Insert | | | SCOTLAND MEMORIAL HOSPITAL | 4/22/2008 10:47 AM |
| Details | Program Code | Insert | | | DSH | 4/22/2008 10:47 AM |
| Details | Entity Subname | Insert | | | | 4/22/2008 10:47 AM |
| Dates | Participating Approval Date | Insert | | | 4/22/2008 10:44:07 AM | 4/22/2008 10:47 AM |
| Details | State | Insert | | | Active | 4/22/2008 10:47 AM |
| Dates | Registration Date | Insert | | | 4/22/2008 12:00:00 AM | 4/22/2008 10:47 AM |
| Dates | Signed By Date | Insert | | | 8/13/2007 12:00:00 AM | 4/22/2008 10:47 AM |
| Dates | Start Date | Insert | | | 7/1/2004 12:00:00 AM | 4/22/2008 10:47 AM |
| Terminations | Termination Comments | Insert | | | | 4/22/2008 10:47 AM |
| Terminations | Termination Date | Insert | | | | 4/22/2008 10:47 AM |
| Terminations | Termination Effective Date | Insert | | | | 4/22/2008 10:47 AM |
| Terminations | Termination Reason | Insert | | | | 4/22/2008 10:47 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 4/22/2008 10:47 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 132322 | 4/22/2008 10:47 AM |
| Medicaid Billing | Medicaid: State | Insert | | | SC | 4/22/2008 10:47 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | True | 4/22/2008 10:47 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 34-00008 | 4/22/2008 10:47 AM |
| Medicaid Billing | Medicaid: State | Insert | | | NC | 4/22/2008 10:47 AM |