340B Drug Pricing Program Database
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NOBLE HEALTH SERVICES INC.
DSH420049 CONWAY HOSPITAL
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Covered Entity Details
Entity Name
CONWAY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH420049
Entity Address
300 SINGLETON RIDGE ROAD
CONWAY, SC 29526
Medicare Provider Number
420049
Participating Start Date
7/1/2019
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
NOBLE HEALTH SERVICES INC.
Pharmacy Address
6040 TARBELL ROAD
SYRACUSE, NY 13206
Pharmacy Comments
Contract Details
Approval Date
1/15/2021
Contract Begin Date
1/18/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/16/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bret Alan Barr, CEO
(843) 347-8114
Contract Pharmacy Representative
KPH Healthcare Services, Inc.
Debbi Barber, 340B Program Director
(315) 287-3600 Ext: 2423
Signed By Date
1/15/2021
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