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LAKE ESCAPE, INC D/B/A
DSH340070 ALAMANCE REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ALAMANCE REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340070
Entity Address
1240 HUFFMAN MILL ROAD
BURLINGTON, NC 27215
Medicare Provider Number
340070
Participating Start Date
7/1/2015
Last Recertification Date
8/29/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
LAKE ESCAPE, INC D/B/A
Pharmacy Address
MEDICAP PHARMACY
378 HARDEN STREET
PO BOX 1144
BURLINGTON, NC 27216
Pharmacy Comments
Contract Details
Approval Date
7/20/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/8/2016
Ownership change
Contacts
Covered Entity Signing Official
Jeffrey Jones, Executive VP and CFO
(336) 832-8005
Contract Pharmacy Representative
David P. Smith, President
(336) 222-9811
Signed By Date
7/20/2015
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