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WINTER PARK DISCOUNT DRUG
DSH340141 Novant Health New Hanover Regional Medical Center
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Covered Entity Details
Entity Name
Novant Health New Hanover Regional Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340141
Entity Address
2131 South 17th Street
Attn: Pharmacy
Wilmington, NC 28401
Medicare Provider Number
340141
Participating Start Date
10/1/2003
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WINTER PARK DISCOUNT DRUG
Pharmacy Address
5220 WRIGHTSVILLE AVE
WILMINGTON, NC 28403-7056
Pharmacy Comments
Contract Details
Approval Date
4/26/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2021
Ownership change
Contacts
Covered Entity Signing Official
EDWIN J. OLLIE, CFO
(910) 343-4699
Contract Pharmacy Representative
Seashore Discount Drug
Davie Waggett, Owner
(910) 791-6278
Signed By Date
4/26/2013
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