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NORTH CAROLINA CVS PHARMACY, L.L.C.
CHC24142-10 HIGH COUNTRY COMMUNITY HEALTH
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Covered Entity Details
Entity Name
HIGH COUNTRY COMMUNITY HEALTH
Subdivision Name
East Burke HCCH
Type
HRSA-Funded Health Center
340B ID
CHC24142-10
Entity Address
560 Malcolm Blvd. STE B
Rutherford College, NC 28671
Grant Number
H80CS24142
Participating Start Date
7/1/2020
Last Recertification Date
2/1/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
NORTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03828
1127 N. BRIDGE STREET
ELKIN, NC 28621
Pharmacy Comments
Contract Details
Approval Date
4/22/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Tiffany Melchers, CFO
(828) 262-3886 Ext: 120
Contract Pharmacy Representative
Wellpartner
Luis Vargas, Account Manager
(401) 772-7341
Signed By Date
4/15/2020
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