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GUILFORD CO HLTH DEPT PHCY
CHC26514-00 TRIAD ADULT AND PEDIATRIC MEDICINE, INC.
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Covered Entity Details
Entity Name
TRIAD ADULT AND PEDIATRIC MEDICINE, INC.
Subdivision Name
TAPM Pediatrics at Wendover
Type
HRSA-Funded Health Center
340B ID
CHC26514-00
Entity Address
1046 E Wendover Ave
Greensboro, NC 27405-6712
Grant Number
H80CS26514
Participating Start Date
1/1/2015
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
GUILFORD CO HLTH DEPT PHCY
Pharmacy Address
1100 E WENDOVER AVE
GREENSBORO, NC 27405-6713
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
Michelle Lewis, CEO
(336) 355-9715
Contract Pharmacy Representative
Guilford County Heath Dept Pharmacy
Mary Elizabeth Batten, Director of Pharmacy
(336) 641-8329
Signed By Date
4/15/2020
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