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NORTH CAROLINA CVS PHARMACY, L.L.C.
CH045630 GASTON FAMILY HEALTH SERVICES INC
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Covered Entity Details
Entity Name
GASTON FAMILY HEALTH SERVICES INC
Subdivision Name
Kintegra Family Medicine - Hudson
Type
HRSA-Funded Health Center
340B ID
CH045630
Entity Address
991 W Hudson Blvd
Gastonia, NC 28052-6430
Grant Number
H80CS00293
Participating Start Date
10/1/1997
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
NORTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04202
1830 WEST DIXON BOULEVARD
SHELBY, NC 28152
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Spencer, CEO
(704) 616-2245
Contract Pharmacy Representative
Caremark L.L.C.
Christian reid, 340b Program Director
(401) 770-2118
Signed By Date
10/14/2020
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