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MEDEXPRESS PHARMACY, LTD.
RW424791 Central Carolina Health Network
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Covered Entity Details
Entity Name
Central Carolina Health Network
Subdivision Name
Type
Ryan White Part D
340B ID
RW424791
Entity Address
1 Centerview Drive
Suite 202
Greensboro, NC 27407
Grant Number
H12HA24791
Participating Start Date
4/1/2015
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
MEDEXPRESS PHARMACY, LTD.
Pharmacy Address
1431 W. INNES ST.
SALISBURY, NC 28144
Pharmacy Comments
Contract Details
Approval Date
3/31/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kent Gammon, President /CEO
(336) 292-0665
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
3/31/2015
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