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BLSRPH, INC.
DSH340068 COLUMBUS REGIONAL HEALTHCARE SYSTEM
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Covered Entity Details
Entity Name
COLUMBUS REGIONAL HEALTHCARE SYSTEM
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340068
Entity Address
500 Jefferson Street
WHITEVILLE, NC 28472
Medicare Provider Number
340068
Participating Start Date
7/1/2004
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
BLSRPH, INC.
Pharmacy Address
D/B/A VILLAGE PRESCRIPTION CENTER
108 E. OLD HIGHWAY 74 76
P.O. BOX 148
LAKE WACCAMAW, NC 28450-2512
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/2/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Marvin Jeffery Armstrong, CFO
(910) 642-1703
Contract Pharmacy Representative
Village Prescription Center
Ben Sauls, Owner
(910) 646-3435
Signed By Date
4/15/2020
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