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NC BAPTIST HOSPITAL, INC
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
NC BAPTIST HOSPITAL, INC
Pharmacy Address
MEDICAL CENTER BLVD
ATTN NC BAPTIST HOSP PHAR
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
11/29/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
DANNY SQUIRES, CFO
(336) 248-5161
Contract Pharmacy Representative
North Carolina Baptist Hospital
Bibi W Wishart, Program Director, 340B
(336) 713-3426
Signed By Date
4/18/2018
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