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HIGH POINT REGIONAL RETAIL PHARMACY
DSH340047 NORTH CAROLINA BAPTIST HOSPITAL
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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
HIGH POINT REGIONAL RETAIL PHARMACY
Pharmacy Address
601 N ELM ST
HIGH POINT, NC 27262-4331
Pharmacy Comments
Contract Details
Approval Date
7/18/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Conrad Emmerich, Sr. Vice President,Hospital & Business Services
(336) 716-8941
Contract Pharmacy Representative
North Carolina Baptist Hospital
Bibi W Wishart, Program Director, 340B
(336) 713-3426
Signed By Date
7/18/2018
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