Contract Pharmacy Details

NORTH CAROLINA CVS PHARMACY, L.L.C.
DSH340047 NORTH CAROLINA BAPTIST HOSPITAL

Covered Entity Details

Entity Name

NORTH CAROLINA BAPTIST HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH340047

Entity Address

MEDICAL CENTER BOULEVARD
WINSTON-SALEM, NC 27157

Medicare Provider Number

340047

Participating Start Date

4/1/1998

Last Recertification Date

8/23/2024

Pharmacy Details

Pharmacy Name

NORTH CAROLINA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05540
189 HICKORY TREE RD STE 120
WINSTON SALEM, NC 27107

Pharmacy Comments

Contract Details

Approval Date

1/6/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Kevin P. High, Executive Vice President, Health Systems Affairs
(336) 716-6211

Contract Pharmacy Representative

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

Signed By Date

1/6/2016

340B Drug Pricing Program Database