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HARRIS TEETER PHARMACY #0341
DSH340004 HIGH POINT REGIONAL HEALTH
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Covered Entity Details
Entity Name
HIGH POINT REGIONAL HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340004
Entity Address
601 North Elm Street
High Point, NC 27262
Medicare Provider Number
340004
Participating Start Date
3/15/2022
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
HARRIS TEETER PHARMACY #0341
Pharmacy Address
265 EASTCHESTER DR, SUITE 121
HIGH POINT, NC 27262
Pharmacy Comments
Contract Details
Approval Date
2/12/2021
Contract Begin Date
3/15/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/6/2023
Business decision by covered entity and/or pharmacy
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
1/15/2021
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