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BELMONT PHARMACY INC
DSH340091 THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION
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Covered Entity Details
Entity Name
THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340091
Entity Address
1200 NORTH ELM STREET
GREENSBORO, NC 27401-1020
Medicare Provider Number
340091
Participating Start Date
4/1/2006
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
BELMONT PHARMACY INC
Pharmacy Address
105 PROFESSIONAL DR
REIDSVILLE, NC 27320-7173
Pharmacy Comments
Contract Details
Approval Date
10/8/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/5/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jeffrey Jones, Executive VP and CFO
(336) 832-8005
Contract Pharmacy Representative
Belmont Pharmacy
Charles A. Britt, President
(336) 342-0071
Signed By Date
10/8/2020
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