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NOVANT HEALTH THOMASVILLE MEDICAL CENTER
RRC340014-00 FORSYTH MEMORIAL HOSPITAL INC
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Covered Entity Details
Entity Name
FORSYTH MEMORIAL HOSPITAL INC
Subdivision Name
Type
Rural Referral Center
340B ID
RRC340014-00
Entity Address
3333 SILAS CREEK PARKWAY
WINSTON SALEM, NC 27103
Medicare Provider Number
340014
Participating Start Date
7/7/2020
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
NOVANT HEALTH THOMASVILLE MEDICAL CENTER
Pharmacy Address
DBA NOVANT HEALTH SPECIALTY PHARMACY
1381 WESTGATE CENTER DR
WINSTON SALEM, NC 27103
Pharmacy Comments
Contract Details
Approval Date
7/7/2020
Contract Begin Date
7/29/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Geoffrey Gardner, SVP Finance
(336) 718-2078
Contract Pharmacy Representative
Novant Health Pharmacy Services
Amy L Wenker, Pharmacy Manager
(336) 277-0210
Signed By Date
7/6/2020
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