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NOVANT HEALTH THOMASVILLE MEDICAL CENTER
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 THOMASVILLE MEDICAL CENTER
Pharmacy Address
DBA NOVANT HEALTH SPECIALTY PHARMACY
1381 WESTGATE CENTER DR
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
7/7/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Sean M. Sanz, SVP & COO NHFMC
(336) 718-2029
Contract Pharmacy Representative
Novant Health Pharmacy Services, LLC
Aimee Smith, Supervisor Pharmacy
(336) 718-1460
Signed By Date
10/28/2016
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