Contract Pharmacy Details

NORTH CAROLINA CVS PHARMACY, L.L.C.
DSH340127 GRANVILLE MEDICAL CENTER

Covered Entity Details

Entity Name

GRANVILLE MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH340127

Entity Address

1010 COLLEGE STREET
OXFORD, NC 27565

Medicare Provider Number

340127

Participating Start Date

7/1/2004

Last Recertification Date

8/23/2024

Pharmacy Details

Pharmacy Name

NORTH CAROLINA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03831
102 N. BICKETT BLVD.
LOUISBURG, NC 27549

Pharmacy Comments

Contract Details

Approval Date

4/12/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/20/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Adam West McConnell, CEO
(919) 690-3402

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/12/2019

340B Drug Pricing Program Database