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FORSYTH MEMORIAL HOSPITAL
RRC340015-00 ROWAN REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
ROWAN REGIONAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC340015-00
Entity Address
612 MOCKSVILLE AVENUE
SALISBURY, NC 28144
Medicare Provider Number
340015
Participating Start Date
1/1/2017
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
FORSYTH MEMORIAL HOSPITAL
Pharmacy Address
DBA NOVANT HEALTH PHARMACY
3333 SILAS CREEK PKWY
WINSTON SALEM, NC 27103-3013
Pharmacy Comments
Contract Details
Approval Date
11/1/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/11/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Darise Caldwell, President and COO - NHRMC
(704) 210-5001
Contract Pharmacy Representative
Novant Health Pharmacy Services, LLC
Jessica McDuffie, Supervisor Retail Pharmacy
(336) 277-8800
Signed By Date
11/1/2016
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