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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 CANCER INSTITUTE
1010 BETHESDA CT
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
9/10/2021
Pharmacy closed
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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