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OLD MAIN PHARMACY
CH049000 ROBESON HEALTH CARE CORP
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Covered Entity Details
Entity Name
ROBESON HEALTH CARE CORP
Subdivision Name
Robeson Health Care Corporation
Type
HRSA-Funded Health Center
340B ID
CH049000
Entity Address
60 Commerce Drive
Pembroke, NC 28372
Grant Number
H80CS00107
Participating Start Date
1/1/2003
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
OLD MAIN PHARMACY
Pharmacy Address
407 W THIRD STREET
PO BOX 2639
PEMBROKE, NC 28372
Pharmacy Comments
Contract Details
Approval Date
3/14/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas E. Manynor II, Deputy President and CEO
(910) 521-2900 Ext: 104
Contract Pharmacy Representative
Justin Daniel, President
(910) 521-5600
Signed By Date
1/15/2013
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