340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
NC BAPTIST HOSPITAL, INC
DSH340096H LEXINGTON MEMORIAL HOSPITAL, INC.
Print
Covered Entity Details
Entity Name
LEXINGTON MEMORIAL HOSPITAL, INC.
Subdivision Name
Pediatrics & Adolescents- Lexington
Type
Disproportionate Share Hospital
340B ID
DSH340096H
Entity Address
13 Medical Park Drive
Lexington, NC 27292
Medicare Provider Number
340096
Outpatient Facility Provider Number
Participating Start Date
7/1/2016
Last Recertification Date
8/16/2018
Entity Termination Date
1/1/2019
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
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
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session