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SAM'S PHARMACY
CH045800 GOSHEN MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
GOSHEN MEDICAL CENTER, INC.
Subdivision Name
GOSHEN MEDICAL CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH045800
Entity Address
444 SW Center St
Faison, NC 28341
Grant Number
H80CS00181
Participating Start Date
7/1/2003
Last Recertification Date
3/10/2025
Pharmacy Details
Pharmacy Name
SAM'S PHARMACY
Pharmacy Address
P.O. BOX 1086
110 S. SYCAMORE ST
ROSE HILL, NC 28458
Pharmacy Comments
Contract Details
Approval Date
5/2/2011
Contract Begin Date
5/2/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2016
Pharmacy closed
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
4/27/2011
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