Contract Pharmacy Details

REALO DISCOUNT DRUG STORES OF EASTERN NC
CH045800 GOSHEN MEDICAL CENTER, INC.

Covered Entity Details

Entity Name

GOSHEN MEDICAL CENTER, INC.

Subdivision Name

GOSHEN MEDICAL CENTER, INC.

Type

HRSA-Funded Health Center

340B ID

CH045800

Entity Address

444 SW Center St
Faison, NC 28341

Grant Number

H80CS00181

Participating Start Date

7/1/2003

Last Recertification Date

3/10/2025

Pharmacy Details

Pharmacy Name

REALO DISCOUNT DRUG STORES OF EASTERN NC

Pharmacy Address

DBA REALO DISCOUNT DRUGS
103 CROSSOVER RD
BEULAVILLE, NC 28518

Pharmacy Comments

Contract Details

Approval Date

8/17/2022

Contract Begin Date

8/18/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/8/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Robin Harrell Smith, Pharmacy Site Leader/Technician
(910) 718-5200

Contract Pharmacy Representative

Realo Discount Drug Stores
Kyle Abode, Pharmacy Director
(252) 639-9006

Signed By Date

8/17/2022

340B Drug Pricing Program Database