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EXPRESS SCRIPTS PHARMACY, INC.
DSH340028 CAPE FEAR VALLEY MEDICAL CENTER
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Covered Entity Details
Entity Name
CAPE FEAR VALLEY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340028
Entity Address
1638 OWEN DRIVE
FAYETTEVILLE, NC 28304
Medicare Provider Number
340028
Participating Start Date
10/1/1999
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
EXPRESS SCRIPTS PHARMACY, INC.
Pharmacy Address
DBA EXPRESS SCRIPTS
2040 ROUTE 130 NORTH
BURLINGTON, NJ 08016
Pharmacy Comments
Contract Details
Approval Date
4/3/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bret David Johnson, Vice President and CFO
(910) 615-6378
Contract Pharmacy Representative
Cape Fear Valley Health System
Thomas Nicholson, Director of Pharmacy
(910) 615-6839
Signed By Date
4/3/2023
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