Contract Pharmacy Details

CENTER STREET PHARMACY
CH045800 GOSHEN MEDICAL CENTER, INC.

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

CENTER STREET PHARMACY

Pharmacy Address

128 N E CENTER STREET
MOUNT OLIVE, NC 28365

Pharmacy Comments

12/13/2011 added address line 2

Contract Details

Approval Date

11/10/2011

Contract Begin Date

11/10/2011

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/1/2017
Pharmacy closed

Contacts

Covered Entity Signing Official

GREG BOUNDS, CEO
(910) 267-1942 Ext: 1117

Contract Pharmacy Representative

Kevin Wilson, Owner
(910) 525-7948

Signed By Date

11/1/2011