Contract Pharmacy Details

Walgreens #21420
CH045800 GOSHEN MEDICAL CENTER, INC.

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

Walgreens #21420

Pharmacy Address

Walgreens Central Fill #21420
8440 Times Dispatch Blvd
Ste. 400
Mechanicsville, VA 23116

Pharmacy Comments

Contract Details

Approval Date

7/10/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Mollianne Kennedy Raynor, PharmacyDirector
(910) 718-5200

Contract Pharmacy Representative

Goshen Medical Center Inc.
Mollianne Kennedy Raynor, PharmacyDirector
(910) 718-5200

Signed By Date

7/10/2023

340B Drug Pricing Program Database