Covered Entity Details

DSH340085H NOVANT HEALTH THOMASVILLE MEDICAL CENTER (Active) - information as of 5/27/2025 2:35:44 PM

Main Details

Name

NOVANT HEALTH THOMASVILLE MEDICAL CENTER

Subdivision Name

NHCI Greensboro Breast Surgery - Oncology Breast Surgery

Type

Disproportionate Share Hospital

Rural

340B ID

DSH340085H

Medicare Provider Number

340085

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/11/2024

Participating Start Date

10/1/2024

Participating Approval Date

8/8/2024

Last Recertification Date

Contacts

Authorizing Official

Novant Health, Inc.
Rebecca A Bean, SVP Chief Pharmacy Executive
(336) 277-5862

Primary Contact

Novant Health, Inc
Elizabeth Anne Corazzo, Pharmacy Manager 340B
(336) 277-0301

Addresses

Street Address

3515 W MARKET STREET
300
GREENSBORO, NC 27403

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
NC		1073861118,1801848767

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH340085A	Child	DSH	NOVANT HEALTH THOMASVILLE MEDICAL CENTER	NOVANT HEALTH CANCER INSTITUTE - Oncology	1710 KERNERSVILLE MEDICAL PKWY	KERNERSVILLE	NC	Active
DSH340085B	Child	DSH	NOVANT HEALTH THOMASVILLE MEDICAL CENTER	NHCI Forsyth Medical Oncology - Oncology	1010 Bethesda Ct	Winston-Salem	NC	Active
DSH340085C	Child	DSH	NOVANT HEALTH THOMASVILLE MEDICAL CENTER	NHCI Forsyth Hematology - Hematology	3333 Silas Creek Pkwy	Winston-Salem	NC	Active
DSH340085D	Child	DSH	NOVANT HEALTH THOMASVILLE MEDICAL CENTER	NOVANT HEALTH CANCER INSTITUTE - Oncology	1213 LEXINGTON AVE	THOMASVILLE	NC	Active
DSH340085E	Child	DSH	NOVANT HEALTH THOMASVILLE MEDICAL CENTER	NH Rheumatology and Arthritis - Rheumatology and Arthritis	1551 WestBrook Plaza Dr	Winston-Salem	NC	Active
DSH340085F	Child	DSH	NOVANT HEALTH THOMASVILLE MEDICAL CENTER	NHCI Symptom Management - Oncology	1010 Bethesda Court	Winston-Salem	NC	Active
DSH340085G	Child	DSH	NOVANT HEALTH THOMASVILLE MEDICAL CENTER	NHCI - Greensboro - Oncology/hematology	3515 W MARKET STREET	GREENSBORO	NC	Active
DSH340085H	Child	DSH	NOVANT HEALTH THOMASVILLE MEDICAL CENTER	NHCI Greensboro Breast Surgery - Oncology Breast Surgery	3515 W MARKET STREET	GREENSBORO	NC	Active
DSH340085J	Child	DSH	NOVANT HEALTH THOMASVILLE MEDICAL CENTER	NH Infusion - Clemmons - Outpatient Infusion	7144 VILLAGE MEDICAL CIR	CLEMMONS	NC	Active
DSH340085K	Child	DSH	NOVANT HEALTH THOMASVILLE MEDICAL CENTER	NH Infusion - Kernersville - Infusion	1730 Kernersville Medical Parkway	KERNERSVILLE	NC	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Addresses	Main Address	Insert	New Registration		3515 W MARKET STREET 300 GREENSBORO, NC 27403	8/8/2024 2:45 PM
Contacts	Signed By	Insert	New Registration		Bean, Rebecca A SVP Chief Pharmacy Executive Novant Health, Inc. 3362775862	8/8/2024 2:45 PM
Details	340B ID	Update	New Registration		DSH340085H	8/8/2024 2:45 PM
Details	Entity Name	Update	New Registration	THOMASVILLE MEDICAL CENTER	NOVANT HEALTH THOMASVILLE MEDICAL CENTER	8/8/2024 2:45 PM
Details	Entity Subname	Update	New Registration	NHCI Greensboro Breast Surgery	NHCI Greensboro Breast Surgery - Oncology Breast Surgery	8/8/2024 2:45 PM
Dates	Participating Approval Date	Update	New Registration		8/8/2024 2:45:53 PM	8/8/2024 2:45 PM
Details	State	Update	New Registration	Pending	Approved	8/8/2024 2:45 PM
Dates	Signed By Date	Update	New Registration		8/8/2024 7:58:41 AM	8/8/2024 2:45 PM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	8/8/2024 2:45 PM
Addresses	Main Address	Insert	New Registration		3515 W MARKET STREET 300 GREENSBORO, NC 27403	8/8/2024 7:58 AM
Addresses	Main Address	Insert	New Registration		3515 W MARKET STREET 300 GREENSBORO, NC 27403	7/12/2024 9:48 AM
Addresses	Main Address	Insert	New Registration		3515 W MARKET STREET 300 GREENSBORO, NC 27012	7/11/2024 2:41 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1073861118	7/11/2024 2:41 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	7/11/2024 2:41 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1801848767	7/11/2024 2:41 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	7/11/2024 2:41 PM
Contacts	Authorizing Official	Insert	New Registration		Bean, Rebecca A SVP Chief Pharmacy Executive Novant Health, Inc. 3362775862	7/11/2024 2:41 PM
Contacts	Primary Contact	Insert	New Registration		Corazzo, Elizabeth Anne Pharmacy Manager 340B Novant Health, Inc 3362770301	7/11/2024 2:41 PM
Details	Assistance Received From Date	Insert	New Registration			7/11/2024 2:41 PM
Details	Assistance Received To Date	Insert	New Registration			7/11/2024 2:41 PM
Details	Last Recertification Date	Insert	New Registration			7/11/2024 2:41 PM
Details	Grant Number	Insert	New Registration			7/11/2024 2:41 PM
Details	340B ID	Insert	New Registration			7/11/2024 2:41 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/11/2024 2:41 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/11/2024 2:41 PM
Details	Medicare Provider Number	Insert	New Registration		340085	7/11/2024 2:41 PM
Details	Entity Name	Insert	New Registration		THOMASVILLE MEDICAL CENTER	7/11/2024 2:41 PM
Details	NOFO Number	Insert	New Registration			7/11/2024 2:41 PM
Details	Program Code	Insert	New Registration		DSH	7/11/2024 2:41 PM
Details	Entity Subname	Insert	New Registration		NHCI Greensboro Breast Surgery	7/11/2024 2:41 PM
Dates	Participating Approval Date	Insert	New Registration			7/11/2024 2:41 PM
Details	State	Insert	New Registration		Pending	7/11/2024 2:41 PM
Dates	Registration Date	Insert	New Registration		7/11/2024 2:41:33 PM	7/11/2024 2:41 PM
Dates	Signed By Date	Insert	New Registration			7/11/2024 2:41 PM
Dates	Start Date	Insert	New Registration			7/11/2024 2:41 PM
Terminations	Termination Comments	Insert	New Registration			7/11/2024 2:41 PM
Terminations	Termination Date	Insert	New Registration			7/11/2024 2:41 PM
Terminations	Termination Effective Date	Insert	New Registration			7/11/2024 2:41 PM
Terminations	Termination Reason	Insert	New Registration			7/11/2024 2:41 PM