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MEDICAL VILLAGE PHARMACY
DSH340008 SCOTLAND MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
SCOTLAND MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340008
Entity Address
500 LAUCHWOOD DRIVE
LAURINBURG, NC 28352
Medicare Provider Number
340008
Participating Start Date
7/1/2004
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
MEDICAL VILLAGE PHARMACY
Pharmacy Address
517 LAUCHWOOD DR
LAURINBURG, NC 28352
Pharmacy Comments
Contract Details
Approval Date
10/8/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/29/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
GREG WOOD, PRESIDENT AND CEO
(910) 291-7000 Ext: 7501
Contract Pharmacy Representative
Ed Herring, Owner
(910) 276-3001
Signed By Date
10/8/2014
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