Contract Pharmacy Details

KENANSVILLE PHARMACY
DSH340120 DUPLIN GENERAL HOSPITAL, INC. D/B/A ECU HEALTH DUPLIN HOSPITAL

Covered Entity Details

Entity Name

DUPLIN GENERAL HOSPITAL, INC. D/B/A ECU HEALTH DUPLIN HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH340120

Entity Address

401 NORTH MAIN STREET
KENANSVILLE, NC 28349

Medicare Provider Number

340120

Participating Start Date

7/1/2004

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

KENANSVILLE PHARMACY

Pharmacy Address

134 LIBERTY SQ STE B
KENANSVILLE, NC 28349

Pharmacy Comments

Contract Details

Approval Date

7/19/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

LUCINDA CRAWFORD, VICE PRESIDENT OF FINANCIAL SERVICES
(910) 296-2608

Contract Pharmacy Representative

Ashley Ezzell
Jennifer Byrd, POC
(910) 296-0500

Signed By Date

7/19/2018

340B Drug Pricing Program Database