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NORTH CAROLINA CVS PHARMACY, L.L.C.
CH045800 GOSHEN MEDICAL CENTER, INC.
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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
NORTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05508
371 S. POPLAR ST. / PO BOX 2066
ELIZABETHTOWN, NC 28337
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
Mollianne Kennedy Raynor, PharmacyDirector
(910) 718-5200
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/3/2023
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