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NORTH CAROLINA CVS PHARMACY, L.L.C.
CAH341317-00 LifeBrite Hospital Group of Stokes, LLC dba LifeBrite Community Hospital of Stokes
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Covered Entity Details
Entity Name
LifeBrite Hospital Group of Stokes, LLC dba LifeBrite Community Hospital of Stokes
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH341317-00
Entity Address
1570 NC 8 & 89 HWY N
Danbury, NC 27016
Medicare Provider Number
341317
Participating Start Date
7/1/2014
Last Recertification Date
11/7/2017
Entity Termination Date
7/1/2018
Pharmacy Details
Pharmacy Name
NORTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 07339
610 N. MAIN ST., PO BOX 869
WALNUT COVE, NC 27052
Pharmacy Comments
Contract Details
Approval Date
5/25/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/26/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joseph S. McNulty III, President
(601) 849-6440
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
4/15/2014
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