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NORTH CAROLINA CVS PHARMACY, L.L.C.
DSH340127 GRANVILLE MEDICAL CENTER
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Covered Entity Details
Entity Name
GRANVILLE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340127
Entity Address
1010 COLLEGE STREET
OXFORD, NC 27565
Medicare Provider Number
340127
Participating Start Date
7/1/2004
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
NORTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06988
11000 CREEDMOOR RD.
RALEIGH, NC 27614
Pharmacy Comments
Contract Details
Approval Date
10/13/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/4/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Adam West McConnell, CEO
(919) 690-3402
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/13/2020
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