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RAINA RX LLC
CAH341324-00 OUTER BANKS HEALTH HOSPITAL DBA
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Covered Entity Details
Entity Name
OUTER BANKS HEALTH HOSPITAL DBA
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH341324-00
Entity Address
4800 S. CROATAN HWY
NAGS HEAD, NC 27959
Medicare Provider Number
341324
Participating Start Date
10/1/2018
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
RAINA RX LLC
Pharmacy Address
DBA ROUTE 300 PHARMACY
1208 ROUTE 300
SUITE 103
NEWBURGH, NY 12550
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Todd Jeffrey Warlitner, Vice President of Finance
(252) 449-4514
Contract Pharmacy Representative
BIOPLUS SPECIALTY PHARMACY
Bill Cook, Executive VP Sales and Business Development
(407) 388-5927 Ext: 4209
Signed By Date
4/15/2020
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