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VIRGINIA CVS PHARMACY, L.L.C.
DSH340127 GRANVILLE MEDICAL CENTER
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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
VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03915
610 N MAIN ST
CHASE CITY, VA 23924
Pharmacy Comments
Contract Details
Approval Date
10/11/2019
Contract Begin Date
1/1/2020
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 Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
10/11/2019
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