Contract Pharmacy Details

FREMONT 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

FREMONT PHARMACY

Pharmacy Address

FREMONT PHARMACY
113 E MAIN ST
FREMONT, NC 27830-9498

Pharmacy Comments

Contract Details

Approval Date

10/4/2013

Contract Begin Date

1/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/13/2021
Pharmacy closed

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Keith Stewart, Vice President
(919) 242-4573

Signed By Date

10/4/2013

340B Drug Pricing Program Database