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GENOA HEALTHCARE, LLC
DSH340047 NORTH CAROLINA BAPTIST HOSPITAL
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Covered Entity Details
Entity Name
NORTH CAROLINA BAPTIST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340047
Entity Address
MEDICAL CENTER BOULEVARD
WINSTON-SALEM, NC 27157
Medicare Provider Number
340047
Participating Start Date
4/1/1998
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE, LLC
Pharmacy Address
2602 COURTIER DRIVE, STE 2200
GREENVILLE, NC 27834-7818
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Michael Thomas Waid, Sr Vice President - Health System Operations and Integration
(336) 716-0433
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/14/2021
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