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NORTH CAROLINA CVS PHARMACY, L.L.C.
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
NORTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 07049
10100 SOUTH MAIN ST
ARCHDALE, NC 27263
Pharmacy Comments
Contract Details
Approval Date
4/6/2021
Contract Begin Date
3/15/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/15/2024
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
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/6/2021
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