Contract Pharmacy Details

NORTH CAROLINA CVS PHARMACY, L.L.C.
DSH340002 MISSION HOSPITALS, INC.

Covered Entity Details

Entity Name

MISSION HOSPITALS, INC.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH340002

Entity Address

509 BILTMORE AVENUE
ASHEVILLE, NC 28801

Medicare Provider Number

340002

Participating Start Date

7/1/2004

Last Recertification Date

8/29/2018

Entity Termination Date

4/1/2019

Pharmacy Details

Pharmacy Name

NORTH CAROLINA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04105
1080 HENDERSONVILLE ROAD
ASHEVILLE, NC 28803

Pharmacy Comments

Contract Details

Approval Date

7/5/2013

Contract Begin Date

10/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/15/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Paul L McDowell, CFO
(828) 213-0184

Contract Pharmacy Representative

John R. Zevzavadjian, Vice President, Managed Care
(401) 770-5503

Signed By Date

7/5/2013

340B Drug Pricing Program Database