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MAST FAMILY DRUG CENTER
DSH340127 GRANVILLE MEDICAL CENTER
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Covered Entity Details
Entity Name
GRANVILLE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340127
Entity Address
1010 COLLEGE STREET
OXFORD, NC 27565
Medicare Provider Number
340127
Participating Start Date
7/1/2004
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
MAST FAMILY DRUG CENTER
Pharmacy Address
418 DABNEY DR
HENDERSON, NC 27536-3944
Pharmacy Comments
Contract Details
Approval Date
7/13/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffery M. Armstrong, CFO
(919) 690-3402
Contract Pharmacy Representative
Gayle Cheek, RPH, Manager
(252) 438-4158
Signed By Date
7/13/2016
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