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ACCREDO HEALTH GROUP, INC.
DSH340047AX NORTH CAROLINA BAPTIST HOSPITAL
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Covered Entity Details
Entity Name
NORTH CAROLINA BAPTIST HOSPITAL
Subdivision Name
VEIN SERVICES CLEMMONS
Type
Disproportionate Share Hospital
340B ID
DSH340047AX
Entity Address
2341 LEWISVILLE-CLEMMONS RD
CLEMMONS, NC 27012
Medicare Provider Number
340047
Outpatient Facility Provider Number
Participating Start Date
4/1/2016
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
2 BOULDEN CIR STE 1
NEW CASTLE, DE 19720-3492
Pharmacy Comments
Contract Details
Approval Date
4/25/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2018
Agreement registered in error
Contacts
Covered Entity Signing Official
Conrad Emmerich, Sr. Vice President,Hospital & Business Services
(336) 716-8941
Contract Pharmacy Representative
Accredo Health Group
Gene McCabe, 340B Sales Director
(615) 943-7500
Signed By Date
4/25/2018
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