Covered Entity Details

CH04403L HEALTH & HUMAN SERVICES, NORTH CAROLINA DEPARTMENT OF (Terminated) - information as of 6/21/2025 12:02:38 AM

Main Details

Name

HEALTH & HUMAN SERVICES, NORTH CAROLINA DEPARTMENT OF

Subdivision Name

SURRY COUNTY HEALTH & NUTRITION CENTER

Type

HRSA-Funded Health Center

Site ID

BPS-H80-001969

340B ID

CH04403L

Grant Number

H80CS00315

Additional Details

Current Program Status

Terminated

Registration Date

3/12/2009

Participating Start Date

4/1/2009

Participating Approval Date

3/13/2009

Last Recertification Date

2/8/2022

Termination Date
Termination Reason

7/1/2022
Loss of qualifying grant/support

Contacts

Authorizing Official

NC DHHS
Elizabeth Freeman Lambar, CEO
(919) 527-6455

Primary Contact

NC Department of Rural Health
Zoe Cummings, 340B PROGRAM MANAGER
(919) 527-6479

Addresses

Street Address

118 Hamby Rd
Dobson, NC 27017-8471

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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?
No

Shipping Addresses

Same as Street Address

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
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH044030	Active	BPS-H80-001033	HEALTH & HUMAN SERVICES, NORTH CAROLINA DEPARTMENT OF	NC DEPARTMENT OF HEALTH AND HUMAN SERVICES	311 ASHE AVE 2009 MAIL SERVIC	RALEIGH	NC
CH04403J	Active	BPS-H80-039343	HEALTH & HUMAN SERVICES, NORTH CAROLINA DEPARTMENT OF	NC FARMWORKERS PROJECT	200 South King Avenue	Dunn	NC
CH04403L	Terminated	BPS-H80-001969	HEALTH & HUMAN SERVICES, NORTH CAROLINA DEPARTMENT OF	SURRY COUNTY HEALTH & NUTRITION CENTER	118 Hamby Rd	Dobson	NC
CH04403M	Terminated	BPS-H80-002024	HEALTH & HUMAN SERVICES, NORTH CAROLINA DEPARTMENT OF	Yancey County Health Department	202 Medical Campus Dr	Burnsville	NC
CH04403S	Terminated	BPS-H80-000238	HEALTH & HUMAN SERVICES, NORTH CAROLINA DEPARTMENT OF	ASHE MEMORIAL HOSPITAL	200 HOSPITAL AVE	JEFFERSON	NC
CH04403T	Terminated	BPS-H80-002509	HEALTH & HUMAN SERVICES, NORTH CAROLINA DEPARTMENT OF	Pender County Health Department	803 S Walker St	Burgaw	NC

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH044030	CARLIE C'S PHARMACY # 870	604 S WALL ST		BENSON	NC	27504-1824	08/26/2009
CH044030	DEES DRUG		111 WRIGHT STREET PO BOX 427	BURGAW	NC	28425	10/01/2013	03/02/2016
CH044030	Good Samaritan Clinic Pharmacy	305 W Union St.		Morganton	NC	28655	07/01/2016	06/20/2017
CH044030	HOSPITAL DRIVE PHARMACY	409 ALTAPASS HWY		SPRUCE PINE	NC	28777	11/01/2009	04/22/2019
CH044030	PEOPLES DRUG	423 E 2ND ST		WEST JEFFERSON	NC	28694-9757	07/01/2009	05/07/2021
CH044030	ROCKY POINT PAVILION PHARMACY	7910 US HWY 117	SUITE 110	ROCKY POINT	NC	28457-2841	07/01/2016	04/22/2019
CH044030	WALLY'S PHARMACY	933 ROCKFORD ST STE 5		MOUNT AIRY	NC	27030	07/10/2009	04/17/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	7/1/2022 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		4/15/2022 12:00:00 AM	4/19/2022 9:58 AM
Details	State	Update	Termination Request	Active	To Be Terminated	4/19/2022 9:58 AM
Terminations	Termination Date	Update	Termination Request		7/1/2022 12:00:00 AM	4/19/2022 9:58 AM
Terminations	Termination Effective Date	Update	Termination Request		4/15/2022 12:00:00 AM	4/19/2022 9:58 AM
Terminations	Termination Reason	Update	Termination Request		Loss of qualifying grant/support	4/19/2022 9:58 AM
Details	Last Recertification Date	Update	Recertification	2/6/2021 6:51:59 AM	2/8/2022 10:48:57 AM	2/8/2022 10:48 AM
Details	Last Recertification Date	Update	Recertification	1/31/2020 11:40:02 AM	2/6/2021 6:51:59 AM	2/6/2021 6:51 AM
Details	Last Recertification Date	Update	Recertification	1/30/2019 9:13:14 AM	1/31/2020 11:40:02 AM	1/31/2020 11:40 AM
Details	Last Recertification Date	Update	Recertification	3/6/2018 1:19:04 PM	1/30/2019 9:13:14 AM	1/30/2019 9:13 AM
Details	Last Recertification Date	Update	Recertification	2/16/2017 12:00:00 AM	3/6/2018 1:19:04 PM	3/6/2018 1:19 PM
Contacts	Authorizing Official	Update		Freeman Lambar, Elizabeth CEO 9195276455	Freeman Lambar, Elizabeth CEO NC DHHS 9195276455	2/8/2018 9:11 AM
Contacts	Primary Contact	Update	Recertification	Cummings, Zoe 340B PROGRAM MANAGER 9195276479	Cummings, Zoe 340B PROGRAM MANAGER NC Department of Rural Health 9195276479	10/25/2017 10:18 AM
Contacts	Authorizing Official	Insert			Freeman Lambar, Elizabeth CEO 9195276455	6/20/2017 2:05 PM
Addresses	Main Address	Insert			118 Hamby Rd Dobson, NC 27017-8471	2/16/2017 10:56 AM
Contacts	Primary Contact	Insert			Cummings, Zoe 340B PROGRAM MANAGER 9195276479	2/16/2017 10:56 AM
Details	Last Recertification Date	Update		3/2/2016 12:00:00 AM	2/16/2017 12:00:00 AM	2/16/2017 10:55 AM
Details	Last Recertification Date	Update		3/10/2015 12:00:00 AM	3/2/2016 12:00:00 AM	3/2/2016 11:20 AM
Details	Last Recertification Date	Update		3/20/2014 12:00:00 AM	3/10/2015 12:00:00 AM	3/10/2015 9:02 AM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/20/2014 12:00:00 AM	3/20/2014 8:58 AM
Details	Entity Name	Update		NC DEPT OF HHS/NC FARMWORKER HEALTH PROGRAM	HEALTH & HUMAN SERVICES, NORTH CAROLINA DEPARTMENT OF	3/20/2014 8:58 AM
Details	Entity Subname	Update		SURRY COUNTY HEALTH AND NUTRITION CENTER	SURRY COUNTY HEALTH & NUTRITION CENTER	3/20/2014 8:58 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/20/2013 12:37 PM
Details	Last Recertification Date	Insert				3/13/2009 9:24 AM
Details	Grant Number	Insert			H80CS00315	3/13/2009 9:24 AM
Details	340B ID	Insert			CH04403L	3/13/2009 9:24 AM
Details	Is Authorizing Official EHB Data	Insert				3/13/2009 9:24 AM
Dates	Last Date That 340B Drugs Purchased	Insert				3/13/2009 9:24 AM
Details	Medicare Provider Number	Insert				3/13/2009 9:24 AM
Details	Entity Name	Insert			NC DEPT OF HHS/NC FARMWORKER HEALTH PROGRAM	3/13/2009 9:24 AM
Details	Program Code	Insert			CH	3/13/2009 9:24 AM
Details	Entity Subname	Insert			SURRY COUNTY HEALTH AND NUTRITION CENTER	3/13/2009 9:24 AM
Dates	Participating Approval Date	Insert			3/13/2009 12:00:00 AM	3/13/2009 9:24 AM
Details	State	Insert			Active	3/13/2009 9:24 AM
Dates	Registration Date	Insert			3/12/2009 12:00:00 AM	3/13/2009 9:24 AM
Dates	Signed By Date	Insert			3/2/2009 12:00:00 AM	3/13/2009 9:24 AM
Dates	Start Date	Insert			4/1/2009 12:00:00 AM	3/13/2009 9:24 AM
Terminations	Termination Comments	Insert				3/13/2009 9:24 AM
Terminations	Termination Date	Insert				3/13/2009 9:24 AM
Terminations	Termination Effective Date	Insert				3/13/2009 9:24 AM
Terminations	Termination Reason	Insert				3/13/2009 9:24 AM

340B Drug Pricing Program Database