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NORTH VILLAGE PHARMACY INC
TB27379 CASWELL COUNTY HEALTH DEPARTMENT
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Covered Entity Details
Entity Name
CASWELL COUNTY HEALTH DEPARTMENT
Subdivision Name
Type
Tuberculosis
340B ID
TB27379
Entity Address
189 COUNTY PARK ROAD
YANCEYVILLE, NC 27379
Grant Number
1NU52PS910292-01-00
Participating Start Date
1/1/2009
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
NORTH VILLAGE PHARMACY INC
Pharmacy Address
1493 MAIN ST
YANCEYVILLE, NC 27379-8793
Pharmacy Comments
Contract Details
Approval Date
7/8/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JENNIFER EASTWOOD, Health Director
(336) 694-4129 Ext: 157
Contract Pharmacy Representative
North Village Pharmacy
Vernon Massengill, Owner
(336) 694-4104
Signed By Date
7/8/2019
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