Covered Entity Details

DSH340053BF Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center (Active) - information as of 6/23/2025 12:30:36 AM

Main Details

Name

Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center

Subdivision Name

NH Infusion - Ballantyne - Outpatient Infusion

Type

Disproportionate Share Hospital

Rural

340B ID

DSH340053BF

Medicare Provider Number

340053

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/11/2024

Participating Start Date

10/1/2024

Participating Approval Date

8/16/2024

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

14135 Ballantyne Corporate Plaza
200
Charlotte, NC 28277

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		1881647204,1174062970,1497708838,1366585200,1245841279

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
DSH340053A	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Senior Care	6324 Fairview Road	Charlotte	NC	Terminated
DSH340053AA	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH HEART & VASCULAR INSTITUTE - MONROE	1640 E ROOSEVELT BLVD	MONROE	NC	Active
DSH340053AB	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH HEART & VASCULAR INSTITUTE - MATTHEWS	1401 MATTHEWS TOWNSHIP PKWY	MATTHEWS	NC	Active
DSH340053AC	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NOVANT HEALTH HEART & VASCULAR INSTITUTE - CHARLOTTE	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AD	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Cancer Institute - Ballantyne	10905 Providence Road West	Charlotte	NC	Active
DSH340053AE	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health PMC Outpatient Observation Beds - Novant Health COH Gastrointestinal 3SW	1901 Randolph Road	Charlotte	NC	Active
DSH340053AF	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health PMC Outpatient Observation Beds - Novant Health COH Med Surg 4SW	1901 Randolph Road	Charlotte	NC	Active
DSH340053AG	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Cancer Institute - University City	8401 UNIVERSITY EXEC PARK DR	CHARLOTTE	NC	Active
DSH340053AH	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Cancer Institute - Mooresville	170 MEDICAL PARK RD	MOORESVILLE	NC	Active
DSH340053AJ	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Presbyterian Medical Center Outpatient Infusion Mint Hill - Outpatient infusion	8201 Healthcare Loop	Charlotte	NC	Active
DSH340053AK	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NOVANT HEALTH CENTER CITY OUTPATIEN - Outpatient Surgery	1901 RANDOLPH RD	CHARLOTTE	NC	Active
DSH340053AL	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Cancer Institute - Huntersville	10030 GILEAD RD	HUNTERSVILLE	NC	Active
DSH340053AM	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health CI Outpatient Infusion Center Elizabeth (PMC)	125 Queens Road	CHARLOTTE	NC	Active
DSH340053AN	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH PMC Wound Care and Hyperbaric Medicine - Wound and Hyperbaric Medicine	300 Billingsly Rd	Charlotte	NC	ToBeTerminated
DSH340053AP	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH BH Outpatient Services Huntersville - Behavioral Health	13815 Professional Center Drive	Huntersville	NC	Active
DSH340053AQ	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INSTITUTE-HEMATOLOGY - HEMATOLOGY	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AR	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INSTITUTE-HEAD AND NECK - HEAD AND NECK ONCOLOGY	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AS	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INSTITUTE - THORACIC - THORACIC ONCOLOGY	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AT	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INSTITUTE PALLIATIVE CARE - PALLIATIVE CARE	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AU	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INST-GYN ONCOLOGY - GYNECOLOGIC ONCOLOGY	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AV	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INST-GASTROINTESTINAL - GI ONCOLOGY	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AW	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INTSTITUE - BREAST - BREAST SURGERY	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AX	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INSTITUTE - CELL THERAPY - HEMATOLOGY/ONCOLOGY	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AY	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INSTITUTE-GENITOURINARY - GENITOURINARY ONCOLOGY	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AZ	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INSTITUTE-INTEGRATED MED - INTEGRATIVE MEDICINE	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053B	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health McKee Internal Medicine	3330 Siskey Parkway	Matthews	NC	Terminated
DSH340053BA	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH Infusion South Park - Infusion	6324 Fairview Rd	Charlotte	NC	Active
DSH340053BB	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH Heart & Vascular - Cardiology	125 Queens Rd	Charlotte	NC	Active
DSH340053BC	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH Outpatient Hospice - Hospice	4105 Matthews Mint Hill Rd	Matthews	NC	Active
DSH340053BD	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH Rheumatology Arthritis South Park - Rheumatology Arthritis	6324 Fairview Rd	Charlotte	NC	Active
DSH340053BE	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NOVANT HEALTH MULTIPLE SCLEROSIS CA - Multiple Sclerosis	6324 FAIRVIEW RD	CHARLOTTE	NC	Active
DSH340053BF	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH Infusion - Ballantyne - Outpatient Infusion	14135 Ballantyne Corporate Plaza	Charlotte	NC	Active
DSH340053BG	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH PMC Sleep Center - Sleep Study	1900 Randolph Rd	Charlotte	NC	Active
DSH340053BH	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Cancer Inst - Elizabeth Caner Risk & Genetics - Oncology	125 Queens Rd	Charlotte	NC	Active
DSH340053C	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Presbyterian Internal Medicine	1918 Randolph Road	Charlotte	NC	Terminated
DSH340053D	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Midtown Outpatient Surgery	1918 Randolph Road	Charlotte	NC	Active
DSH340053E	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Outpatient Surgery	1800 East 4th Street	Charlotte	NC	Active
DSH340053F	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Heart & Vascular Institute (Heart Failure Clinic)	1718 East 4th Street	Charlotte	NC	Terminated
DSH340053G	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Outpatient Infusion at Huntersville	10030 Gilead Road	Huntersville	NC	Active
DSH340053H	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Cancer Institute - Matthews	1700 Matthews Township Parkway	Matthews	NC	Active
DSH340053J	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	St. Jude Affiliate Clinic at Novant Health Hemby Children’s Hospital	301 Hawthorne Lane	Charlotte	NC	Active
DSH340053K	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital EKG	1901 Randolph Road	Charlotte	NC	Active
DSH340053L	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital Occupational Therapy	1901 Randolph Road	Charlotte	NC	Active
DSH340053M	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital Physical Therapy	1901 Randolph Road	Charlotte	NC	Active
DSH340053N	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital Respiratory Therapy	1901 Randolph Road	Charlotte	NC	Active
DSH340053P	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital MRI	1901 Randolph Road	Charlotte	NC	Active
DSH340053Q	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital CT Scan	1901 Randolph Road	Charlotte	NC	Active
DSH340053R	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital Radiology -Diagnostics	1901 Randolph Road	Charlotte	NC	Active
DSH340053S	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital Anesthesiology	1901 Randolph Road	Charlotte	NC	Active
DSH340053T	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital Operating Room	1901 Randolph Road	Charlotte	NC	Active
DSH340053U	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Outpatient Infusion at Matthews	1500 Matthews Township Pkwy	Matthews	NC	Active
DSH340053V	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital Pain Management Center	1901 Randolph Road	Charlotte	NC	Terminated
DSH340053W	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital Lithotripsy	1901 Randolph Road	Charlotte	NC	Terminated
DSH340053X	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital Total Joint Unit Observation Beds	1901 Randolph Road	Charlotte	NC	Terminated
DSH340053Y	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopaedic Hospital Orthopaedic Spine Unit - Observation Beds	1901 Randolph Road	Charlotte	NC	Active
DSH340053Z	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NOVANT HEALTH HEART & VASCULAR INSTITUTE - HUNTERSVILLE	10030 GILEAD ROAD	HUNTERSVILLE	NC	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Bean, Rebecca A SVP Chief Pharmacy Executive Novant Health, Inc. 3362775862	8/16/2024 2:29 PM
Details	340B ID	Update	New Registration		DSH340053BF	8/16/2024 2:29 PM
Details	Entity Name	Update	New Registration	PRESBYTERIAN HOSPITAL	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	8/16/2024 2:29 PM
Details	Entity Subname	Update	New Registration	NH Infusion - Ballantyne	NH Infusion - Ballantyne - Outpatient Infusion	8/16/2024 2:29 PM
Dates	Participating Approval Date	Update	New Registration		8/16/2024 2:29:33 PM	8/16/2024 2:29 PM
Details	State	Update	New Registration	Pending	Approved	8/16/2024 2:29 PM
Dates	Signed By Date	Update	New Registration		8/2/2024 8:46:47 AM	8/16/2024 2:29 PM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	8/16/2024 2:29 PM
Addresses	Main Address	Insert	New Registration		14135 Ballantyne Corporate Plaza 200 Charlotte, NC 28277	7/11/2024 3:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1881647204	7/11/2024 3:14 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	7/11/2024 3:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1174062970	7/11/2024 3:14 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	7/11/2024 3:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1497708838	7/11/2024 3:14 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	7/11/2024 3:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1366585200	7/11/2024 3:14 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	7/11/2024 3:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1245841279	7/11/2024 3:14 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	7/11/2024 3:14 PM
Contacts	Authorizing Official	Insert	New Registration		Bean, Rebecca A SVP Chief Pharmacy Executive Novant Health, Inc. 3362775862	7/11/2024 3:14 PM
Contacts	Primary Contact	Insert	New Registration		Corazzo, Elizabeth Anne Pharmacy Manager 340B Novant Health, Inc 3362770301	7/11/2024 3:14 PM
Details	Assistance Received From Date	Insert	New Registration			7/11/2024 3:14 PM
Details	Assistance Received To Date	Insert	New Registration			7/11/2024 3:14 PM
Details	Last Recertification Date	Insert	New Registration			7/11/2024 3:14 PM
Details	Grant Number	Insert	New Registration			7/11/2024 3:14 PM
Details	340B ID	Insert	New Registration			7/11/2024 3:14 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/11/2024 3:14 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/11/2024 3:14 PM
Details	Medicare Provider Number	Insert	New Registration		340053	7/11/2024 3:14 PM
Details	Entity Name	Insert	New Registration		PRESBYTERIAN HOSPITAL	7/11/2024 3:14 PM
Details	NOFO Number	Insert	New Registration			7/11/2024 3:14 PM
Details	Program Code	Insert	New Registration		DSH	7/11/2024 3:14 PM
Details	Entity Subname	Insert	New Registration		NH Infusion - Ballantyne	7/11/2024 3:14 PM
Dates	Participating Approval Date	Insert	New Registration			7/11/2024 3:14 PM
Details	State	Insert	New Registration		Pending	7/11/2024 3:14 PM
Dates	Registration Date	Insert	New Registration		7/11/2024 3:14:51 PM	7/11/2024 3:14 PM
Dates	Signed By Date	Insert	New Registration			7/11/2024 3:14 PM
Dates	Start Date	Insert	New Registration			7/11/2024 3:14 PM
Terminations	Termination Comments	Insert	New Registration			7/11/2024 3:14 PM
Terminations	Termination Date	Insert	New Registration			7/11/2024 3:14 PM
Terminations	Termination Effective Date	Insert	New Registration			7/11/2024 3:14 PM
Terminations	Termination Reason	Insert	New Registration			7/11/2024 3:14 PM