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NORTH CAROLINA CVS PHARMACY, L.L.C.
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
NORTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 07046
14636 US HWY 17 N
HAMPSTEAD, NC 28443
Pharmacy Comments
Contract Details
Approval Date
1/14/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
EDWIN J. OLLIE, CFO
(910) 343-4699
Contract Pharmacy Representative
CVS Health
Jaclyn Parfitt, 340B Operations Manager
(401) 770-6467
Signed By Date
1/14/2016
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