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SUMMIT PHARMACY AND SURGICAL SUPPLIES LL
DSH340091 THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION
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Covered Entity Details
Entity Name
THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340091
Entity Address
1200 NORTH ELM STREET
GREENSBORO, NC 27401-1020
Medicare Provider Number
340091
Participating Start Date
4/1/2006
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
SUMMIT PHARMACY AND SURGICAL SUPPLIES LL
Pharmacy Address
930 SUMMIT AVE
GREENSBORO, NC 27405
Pharmacy Comments
Contract Details
Approval Date
4/9/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/7/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Andrew Barrow, Chief Financial Officer
(336) 832-7825
Contract Pharmacy Representative
Summit Pharmacy and Surgical Supply LLC
Vishal Patel, Pharmacy Manager
(336) 736-7282
Signed By Date
4/9/2021
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