340B Drug Pricing Program Database
WAKEMED OUTPATIENT PHARMACY-MEDICAL PARK
DSH340069 WAKEMED - information as of 6/26/2025 1:10:34 AM
Covered Entity Details
Entity Name
WAKEMED
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340069
Entity Address
3000 NEW BERN AVENUE
RALEIGH, NC 27610
Medicare Provider Number
340069
Participating Start Date
1/1/2016
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAKEMED OUTPATIENT PHARMACY-MEDICAL PARK
Pharmacy Address
210 ASHVILLE AVE STE 100
CARY, NC 27518
Pharmacy Comments
Contract Details
Approval Date
1/7/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DONALD GINTZIG, President and CEO
(919) 350-8102
Contract Pharmacy Representative
WakeMed
Alex Jenkins, Ambulatory Services Manager
(919) 350-7065
Signed By Date
1/7/2021
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