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MCDOWELL COMMUNITY PHARMACY
DSH340002 MISSION HOSPITALS, INC.
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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
MCDOWELL COMMUNITY PHARMACY
Pharmacy Address
401 Nebo School Rd
Nebo, NC 28761
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Paul L McDowell, CFO
(828) 213-0184
Contract Pharmacy Representative
Mission Health
Tim Gentilcore, Director, Retail Pharmacy
(828) 213-0048
Signed By Date
7/17/2017
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