Contract Pharmacy Details

NOVANT HEALTH PHARMACY SERVICES LLC
DSH340014 Forsyth Memorial Hospital, Inc d/b/a Novant Health Forsyth Medical Center

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
255 CHARLOIS BLVD
WINSTON-SALEM, NC 27103

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

Karen Ewing, Manager Retail Pharmacy
(336) 718-1044

Signed By Date

10/28/2016

340B Drug Pricing Program Database