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FORSYTH MEMORIAL HOSPITAL
DSH340085 NOVANT HEALTH THOMASVILLE MEDICAL CENTER
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Covered Entity Details
Entity Name
NOVANT HEALTH THOMASVILLE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340085
Entity Address
207 OLD LEXINGTON ROAD
THOMASVILLE, NC 27360
Medicare Provider Number
340085
Participating Start Date
7/1/2004
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
FORSYTH MEMORIAL HOSPITAL
Pharmacy Address
DBA NOVANT HEALTH PHARMACY
3333 SILAS CREEK PKWY
WINSTON SALEM, NC 27103-3013
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
12/31/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Allison J. Greear, Interim President and COO
(336) 476-2526
Contract Pharmacy Representative
Matthew Brown, Director Pharmacy
(336) 277-8973
Signed By Date
10/28/2016
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