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GUILFORD CTY HLTH DEPT PHARM
CHC26514-06 TRIAD ADULT AND PEDIATRIC MEDICINE, INC.
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Covered Entity Details
Entity Name
TRIAD ADULT AND PEDIATRIC MEDICINE, INC.
Subdivision Name
TAPM Pediatrics at E. Commerce
Type
HRSA-Funded Health Center
340B ID
CHC26514-06
Entity Address
400 E Commerce St
High Point, NC 27260-5221
Grant Number
H80CS26514
Participating Start Date
1/1/2015
Last Recertification Date
2/24/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
GUILFORD CTY HLTH DEPT PHARM
Pharmacy Address
501 E GREEN DR
HIGH POINT, NC 27260-6707
Pharmacy Comments
Contract Details
Approval Date
10/29/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michelle Lewis, CEO
(336) 355-9715
Contract Pharmacy Representative
Mary Elizabeth Batten, Director of Pharmacy
(336) 641-8037
Signed By Date
10/29/2015
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