Contract Pharmacy Details

NORTH CAROLINA CVS PHARMACY, L.L.C.
RRC340004-00 HIGH POINT REGIONAL HEALTH

Covered Entity Details

Entity Name

HIGH POINT REGIONAL HEALTH

Subdivision Name

Type

Rural Referral Center

340B ID

RRC340004-00

Entity Address

601 North Elm Street
High Point, NC 27262

Medicare Provider Number

340004

Participating Start Date

12/27/2021

Last Recertification Date

Entity Termination Date

3/15/2022

Pharmacy Details

Pharmacy Name

NORTH CAROLINA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07544
285 N FAYETTEVILLE ST
ASHEBORO, NC 27203

Pharmacy Comments

Contract Details

Approval Date

10/6/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Kevin Edwin Smith, Vice President, Chief Operating Officer
(336) 781-2181

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/6/2020

340B Drug Pricing Program Database