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ROCK DRUG OF VALDESE, LLC
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
ROCK DRUG OF VALDESE, LLC
Pharmacy Address
DBA ROCK DRUG STORE
240 MAIN ST W
VALDESE, NC 28690-2835
Pharmacy Comments
Contract Details
Approval Date
7/6/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KATHY BAILEY, CEO
(828) 580-5586
Contract Pharmacy Representative
Bruce Cannon, Owner
(828) 433-5120
Signed By Date
7/6/2015
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