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HARRIS TEETER PHARMACY #0173
RRC340004-00 HIGH POINT REGIONAL HEALTH
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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
HARRIS TEETER PHARMACY #0173
Pharmacy Address
1589 SKEET CLUB RD, SUITE 140
SUITE 140
HIGH POINT, NC 27265
Pharmacy Comments
Contract Details
Approval Date
10/16/2020
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
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/16/2020
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