340B Drug Pricing Program Database
NORTH CAROLINA CVS PHARMACY, L.L.C.
DSH340047 NORTH CAROLINA BAPTIST HOSPITAL - information as of 4/29/2025 2:14:42 AM
Covered Entity Details
Entity Name
NORTH CAROLINA BAPTIST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340047
Entity Address
MEDICAL CENTER BOULEVARD
WINSTON-SALEM, NC 27157
Medicare Provider Number
340047
Participating Start Date
4/1/1998
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
NORTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03511
2221 CLOVERDALE AVE
WINSTON SALEM, NC 27103
Pharmacy Comments
Contract Details
Approval Date
1/6/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/25/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Kevin P. High, Executive Vice President, Health Systems Affairs
(336) 716-6211
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/6/2016
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