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NORTH CAROLINA CVS PHARMACY, L.L.C.
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
NORTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 07031
2210 FLEMING RD.
GREENSBORO, NC 27410
Pharmacy Comments
11/28/2012 zip update (was 28410)
Contract Details
Approval Date
8/22/2012
Contract Begin Date
8/22/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Romig, Vice President of Pharmacy Services and Supply Chain
(336) 832-7807
Contract Pharmacy Representative
Scott Tierney, Senior Director, Payer Relations
(401) 770-2762
Signed By Date
8/10/2012
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