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CAROLINACARE PHARMACY
CAH341322-00 AdventHealth Polk
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Covered Entity Details
Entity Name
AdventHealth Polk
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH341322-00
Entity Address
101 HOSPITAL DRIVE
COLUMBUS, NC 28722
Medicare Provider Number
341322
Participating Start Date
7/1/2017
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
CAROLINACARE PHARMACY
Pharmacy Address
P O BOX 31691
4400 GOLF ACRES DRIVE
BUILDING J, SUITE C
CHARLOTTE, NC 28208
Pharmacy Comments
Contract Details
Approval Date
4/13/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2018
Agreement registered in error
Contacts
Covered Entity Signing Official
Elizabeth Presnell, CFO
(828) 894-0954
Contract Pharmacy Representative
CarolinaCare
Frank McCree, Pharmacy Director
(704) 512-7621
Signed By Date
4/13/2018
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