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HOSPITAL DRIVE PHARMACY
CH044030 HEALTH & HUMAN SERVICES, NORTH CAROLINA DEPARTMENT OF
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Covered Entity Details
Entity Name
HEALTH & HUMAN SERVICES, NORTH CAROLINA DEPARTMENT OF
Subdivision Name
NC DEPARTMENT OF HEALTH AND HUMAN SERVICES
Type
HRSA-Funded Health Center
340B ID
CH044030
Entity Address
311 ASHE AVE 2009 MAIL SERVIC
RALEIGH, NC 27606-2102
Grant Number
H80CS00315
Participating Start Date
7/1/2004
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
HOSPITAL DRIVE PHARMACY
Pharmacy Address
409 ALTAPASS HWY
SPRUCE PINE, NC 28777
Pharmacy Comments
Contract Details
Approval Date
11/1/2009
Contract Begin Date
11/1/2009
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/22/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Zoe Cummings, 340B PROGRAM MANAGER
(919) 527-6479
Contract Pharmacy Representative
Robert G. Proffitt, Owner
(828) 765-2025
Signed By Date
10/20/2009
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