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NOVANT HEALTH PHARMACY SERVICES LLC
DSH340014 Forsyth Memorial Hospital, Inc d/b/a Novant Health Forsyth Medical Center
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Covered Entity Details
Entity Name
Forsyth Memorial Hospital, Inc d/b/a Novant Health Forsyth Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340014
Entity Address
3333 SILAS CREEK PARKWAY
WINSTON-SALEM, NC 27103-3013
Medicare Provider Number
340014
Participating Start Date
7/1/2007
Last Recertification Date
9/6/2019
Entity Termination Date
7/7/2020
Pharmacy Details
Pharmacy Name
NOVANT HEALTH PHARMACY SERVICES LLC
Pharmacy Address
DBA: NOVANT HEALTH PHARMACY
3333 SILAS CREEK PARKWAY
RETAIL PHARMACY - MAIN FLOOR - LOBBY
WINSTON SALEM, NC 27103-3090
Pharmacy Comments
Contract Details
Approval Date
10/28/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/11/2019
Ownership change
Contacts
Covered Entity Signing Official
Sean M. Sanz, SVP & COO NHFMC
(336) 718-2029
Contract Pharmacy Representative
Novant Health Pharmacy Services, LLC
Steven Miller, Supervisor Pharmacy
(336) 277-8990
Signed By Date
10/28/2016
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