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BAPTIST HOSPITAL SPECIALTY RX
DSH340096 LEXINGTON MEMORIAL HOSPITAL, INC.
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Covered Entity Details
Entity Name
LEXINGTON MEMORIAL HOSPITAL, INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340096
Entity Address
250 HOSPITAL DRIVE
LEXINGTON, NC 27292
Medicare Provider Number
340096
Participating Start Date
9/9/2005
Last Recertification Date
9/16/2019
Entity Termination Date
1/1/2020
Pharmacy Details
Pharmacy Name
BAPTIST HOSPITAL SPECIALTY RX
Pharmacy Address
NORTH TOWER GROUND FLOOR
MEDICAL CENTER BLVD
WINSTON SALEM, NC 27157
Pharmacy Comments
Contract Details
Approval Date
4/18/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/16/2018
Agreement registered in error
Contacts
Covered Entity Signing Official
DANNY SQUIRES, CFO
(336) 248-5161
Contract Pharmacy Representative
NORTH CAROLINA BAPTIST HOSPITAL
Martin Konopko, System Manager 340b
(336) 713-9418
Signed By Date
4/18/2018
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