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KMART PHARMACY
DSH340075 Blue Ridge HealthCare Hospitals, Inc
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Covered Entity Details
Entity Name
Blue Ridge HealthCare Hospitals, Inc
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340075
Entity Address
2201 SOUTH STERLING STREET
MORGANTON, NC 28655
Medicare Provider Number
340075
Participating Start Date
12/6/2005
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
KMART PHARMACY
Pharmacy Address
110 BOST RD # 112
MORGANTON, NC 28655-5616
Pharmacy Comments
Contract Details
Approval Date
7/30/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/15/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
KATHY BAILEY, CEO
(828) 580-5586
Contract Pharmacy Representative
Beth Zander, Director, Managed Care Services
(847) 286-7661
Signed By Date
7/30/2014
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