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NORTH CAROLINA CVS PHARMACY, L.L.C.
DSH340028 CAPE FEAR VALLEY MEDICAL CENTER
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Covered Entity Details
Entity Name
CAPE FEAR VALLEY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340028
Entity Address
1638 OWEN DRIVE
FAYETTEVILLE, NC 28304
Medicare Provider Number
340028
Participating Start Date
10/1/1999
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
NORTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04095
3026 BRAGG BLVD.
FAYETTEVILLE, NC 28303
Pharmacy Comments
Contract Details
Approval Date
4/8/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bret David Johnson, Vice President and CFO
(910) 615-6378
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/8/2025
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