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FAISON 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
FAISON PHARMACY
Pharmacy Address
206 SW CENTER ST
FAISON, NC 28341
Pharmacy Comments
Contract Details
Approval Date
7/1/2003
Contract Begin Date
7/1/2003
Carve-In Effective Date
Contract Comments
2/21/2006 - CORRECTION IN CONTRACT BEGIN DATE, INCORRECTLY GIVEN CONTRACT BEGIN DATE OF 4/1/2003 ORIGINALLY
Contract Termination Date
Termination Reason
7/23/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
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