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JOHNSTON HEALTH OUTPATIENT PHARMACY
DSH340090 Johnston Health Services Corporation
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Covered Entity Details
Entity Name
Johnston Health Services Corporation
Subdivision Name
Johnston Memorial Hospital
Type
Disproportionate Share Hospital
340B ID
DSH340090
Entity Address
509 N BRIGHTLEAF BLVD
SMITHFIELD, NC 27577
Medicare Provider Number
340090
Participating Start Date
7/1/2004
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
JOHNSTON HEALTH OUTPATIENT PHARMACY
Pharmacy Address
JOHNSTON HEALTH SERVICES CORPORATION
509 N BRIGHTLEAF BLVD
PO BOX 1376
SMITHFIELD, NC 27577-4407
Pharmacy Comments
Contract Details
Approval Date
4/1/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/29/2016
Agreement registered in error
Contacts
Covered Entity Signing Official
Charles W. Elliott Jr., CEO
(919) 938-7111
Contract Pharmacy Representative
Donna Dewberry, Outpatient Pharmacy Coordinator
(919) 938-7386
Signed By Date
4/1/2015
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