Contract Pharmacy Details

NORTH CAROLINA CVS PHARMACY, L.L.C.
DSH340023 ADVENTHEALTH HENDERSONVILLE

Covered Entity Details

Entity Name

ADVENTHEALTH HENDERSONVILLE

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH340023

Entity Address

100 HOSPITAL DRIVE
HENDERSONVILLE, NC 28792

Medicare Provider Number

340023

Participating Start Date

4/1/2025

Last Recertification Date

Pharmacy Details

Pharmacy Name

NORTH CAROLINA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04467
128 CROSS ROAD DR.
MILLS RIVER, NC 28759

Pharmacy Comments

Contract Details

Approval Date

2/6/2025

Contract Begin Date

4/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Steven Burroughs, VP of Finance / CFO
(828) 681-2102

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/9/2025

340B Drug Pricing Program Database