340B Drug Pricing Program Database


DSH340113DS CAROLINAS MEDICAL CENTER (Active) - information as of 5/4/2025 10:26:43 PM

Main Details
CAROLINAS MEDICAL CENTER
Morehead Imaging Center - NM
Disproportionate Share Hospital
No
DSH340113DS
340113


Additional Details
Active
7/15/2024
10/1/2024
7/23/2024

Contacts

Atrium Health
Don McCoy Mabe, VP, Pharmacy
(704) 512-7623

North Carolina Baptist Hospital
Bibi W Wishart, Program Director, 340B
(336) 713-3426

Addresses

1025 Morehead Medical Drive
Suite 100
Charlotte, NC 28204

Atrium Health Accounts Payable
PO Box 516
Elmsford, NY 10523


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
SC3366881295789907
NC 1295789907
Shipping Addresses

Morehead Imaging Center
1025 Morehead Medical Drive
Suite 100
Charlotte, NC 28204

Carolinas Medical Center
1000 Blythe Blvd
Pharmacy
Charlotte, NC 28203
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH340113AChildDSHCAROLINAS MEDICAL CENTERAtrium Health Biddle Point1801 ROZZELLES FERRY ROADCHARLOTTENCActive
DSH340113AAChildDSHCAROLINAS MEDICAL CENTERAtrium Health Transplant Center - Kidney1025 Morehead Medical DriveCharlotteNCActive
DSH340113ABChildDSHCAROLINAS MEDICAL CENTERAtrium Health Transplant Center - Heart1025 Morehead Medical DriveCharlotteNCTerminated
DSH340113ACChildDSHCAROLINAS MEDICAL CENTERAtrium Health Transplant Center - Liver1025 Morehead Medical DriveCharlotteNCActive
DSH340113ADChildDSHCAROLINAS MEDICAL CENTERAtrium Health Transplant Center - Pancreas1025 Morehead Medical DriveCharlotteNCActive
DSH340113AFChildDSHCAROLINAS MEDICAL CENTERAtrium Health Transplant & Liver Care1025 Morehead Medical DriveCharlotteNCActive
DSH340113AGChildDSHCAROLINAS MEDICAL CENTERRadiation Oncology1310 E. Morehead StCharlotteNCActive
DSH340113AHChildDSHCAROLINAS MEDICAL CENTERAtrium Health Heart Success and Transition Clinic1237 Harding PlaceCharlotteNCActive
DSH340113AJChildDSHCAROLINAS MEDICAL CENTERNuclear Medicine1000 Blythe BlvdCharlotteNCTerminated
DSH340113AKChildDSHCAROLINAS MEDICAL CENTERCMC NorthPark After-Hours Pediatric Clinic251 Eastway DriveCharlotteNCTerminated
DSH340113ALChildDSHCAROLINAS MEDICAL CENTERCMC-Mercy Sleep Disorder Lab2001 Vail AvenueCharlotteNCTerminated
DSH340113AMChildDSHCAROLINAS MEDICAL CENTERAtrium Health Myers Park - Orthopedics1350 S. Kings DriveCharlotteNCActive
DSH340113ANChildDSHCAROLINAS MEDICAL CENTERAtrium Health Myers Park - General Surgery1350 S. Kings DriveCharlotteNCActive
DSH340113APChildDSHCAROLINAS MEDICAL CENTERAtrium Health Myers Park - Obstetrics & Gynecology1350 S. Kings DriveCharlotteNCActive
DSH340113AQChildDSHCAROLINAS MEDICAL CENTERAtrium Health Myers Park - Pediatrics1350 S. Kings DriveCharlotteNCActive
DSH340113ARChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute Infusion Center100 Medical Park DriveConcordNCActive
DSH340113ASChildDSHCAROLINAS MEDICAL CENTERAtrium Health Myers Park - Internal Medicine1350 S. Kings DriveCharlotteNCActive
DSH340113ATChildDSHCAROLINAS MEDICAL CENTERAtrium Health NorthPark - Obstetrics & Gynecology251 Eastway DriveCharlotteNCActive
DSH340113AUChildDSHCAROLINAS MEDICAL CENTERSoutheast Pain Care Center3030 Randolph RoadCharlotteNCTerminated
DSH340113AVChildDSHCAROLINAS MEDICAL CENTERCarolinas Wound Care Center1601 Abbey PlaceCharlotteNCTerminated
DSH340113AWChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute Infusion Center945 North Fifth StreetAlbemarleNCActive
DSH340113AXChildDSHCAROLINAS MEDICAL CENTERCMC-Mercy Emergency Department2001 Vail AvenueCharlotteNCTerminated
DSH340113AYChildDSHCAROLINAS MEDICAL CENTERCMC-Mercy Kidney Dialysis Unit2001 Vail AvenueCharlotteNCTerminated
DSH340113AZChildDSHCAROLINAS MEDICAL CENTERCMC-Mercy Same Day Procedures2001 Vail AvenueCharlotteNCTerminated
DSH340113BChildDSHCAROLINAS MEDICAL CENTERAtrium Health NorthPark - Family Medicine251 EASTWAY DRIVECHARLOTTENCActive
DSH340113BAChildDSHCAROLINAS MEDICAL CENTERCMC-Mercy Endoscopy2001 Vail AvenueCharlotteNCTerminated
DSH340113BBChildDSHCAROLINAS MEDICAL CENTERAtrium Health Myers Park - Internal Medicine Specialty1350 S. Kings DriveCharlotteNCActive
DSH340113BCChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute Medical Oncology Clinic1021 Morehead Medical DrCharlotteNCActive
DSH340113BDChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute Rare/Complex Clinic1021 Morehead Medical DriveCharlotteNCActive
DSH340113BEChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute Breast Clinic1021 Morehead Medical DriveCharlotteNCActive
DSH340113BFChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute GYN Clinic1021 Morehead Medical DriveCharlotteNCTerminated
DSH340113BGChildDSHCAROLINAS MEDICAL CENTERLevine Cancer GU Clinic1021 Morehead Medical DriveCharlotteNCActive
DSH340113BHChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute Gynecological Oncology Clinic1021 Morehead Medical DriveCharlotteNCActive
DSH340113BJChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute Surgical Oncology1021 Morehead Medical DriveCharlotteNCToBeTerminated
DSH340113BKChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute / Infusion Center4525 Cameron Valley ParkwayCharlotteNCActive
DSH340113BLChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute / Medical Oncology4525 Cameron Valley ParkwayCharlotteNCActive
DSH340113BMChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute / Infusion Center10660 Park RoadCharlotteNCActive
DSH340113BNChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute / Medical Oncology10660 Park RoadCharlotteNCActive
DSH340113BPChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute / Infusion Center101 WT Harris BlvdCharlotteNCActive
DSH340113BQChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute / Medical Oncology101 WT Harris BlvdCharlotteNCActive
DSH340113BRChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute / Infusion Center (0001 344200)1100 South Tryon StCharlotteNCTerminated
DSH340113BSChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute / Medical Oncology (0001 344400)1100 South Tryon StCharlotteNCTerminated
DSH340113BTChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute / Infusion Center (0001 342800)10826 Mallard Creek RoadCharlotteNCTerminated
DSH340113BUChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute / Medical Oncology (0001 343700)10826 Mallard Creek RoadCharlotteNCTerminated
DSH340113BVChildDSHCAROLINAS MEDICAL CENTERHPB (Hepato-Pancreatico-Biliary) Surgery1025 Morehead Medical DriveCharlotteNCActive
DSH340113BWChildDSHCAROLINAS MEDICAL CENTERAtrium Health Behavioral Health Primary Care501 Billingsley Rd.CharlotteNCTerminated
DSH340113BXChildDSHCAROLINAS MEDICAL CENTERAtrium Health SouthPark Emergency Department6965 Fairview Rd.CharlotteNCActive
DSH340113BYChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute Medical Oncology Clinic Concord100 Medical Park DriveConcordNCActive
DSH340113BZChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute Medical Oncology Clinic Albemarle945 North Fifth StreetAlbemarleNCActive
DSH340113CChildDSHCAROLINAS MEDICAL CENTERAtrium Health Behavioral Health Emergency Department501 BILLINGSLEY ROADCHARLOTTENCActive
DSH340113CAChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute / Hematology and Lymphoma Clinic1021 Morehead Medical DriveCharlotteNCActive
DSH340113CBChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute / Sickle Cell Clinic1021 Morehead Medical DriveCharlotteNCActive
DSH340113CCChildDSHCAROLINAS MEDICAL CENTERAtrium Health Heart Failure (CHF) Clinic1025 Medical Center DriveCharlotteNCTerminated
DSH340113CDChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute Infusion Center (0001 331300)1401 Matthews Township PkwyMatthewsNCTerminated
DSH340113CEChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute Medical Oncology Clinic (0001 331400)1401 Matthews Township PkwyMatthewsNCTerminated
DSH340113CFChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute Infusion Center15830 Ballantyne Medical PlaceCharlotteNCActive
DSH340113CGChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute Medical Oncology Clinic15830 BALLANTYNE MEDICAL PLACECHARLOTTENCActive
DSH340113CHChildDSHCAROLINAS MEDICAL CENTERAtrium Health Gastroenterology & Hepatology1025 Morehead Medical DriveCharlotteNCActive
DSH340113CJChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute Survivorship / Survivorship (338600)711 E. Morehead StCharlotteNCTerminated
DSH340113CKChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute Palliative Care1021 Morehead Medical DrCharlotteNCActive
DSH340113CLChildDSHCAROLINAS MEDICAL CENTERAtrium Health Neurosciences Institute / ALS Center, and Neuromuscular, Movement, and Headache Programs1010 Edgehill RdCharlotteNCActive
DSH340113CMChildDSHCAROLINAS MEDICAL CENTERAtrium Health Neurosciences Institute / Infusion Service1225 Harding PlaceCharlotteNCActive
DSH340113CNChildDSHCAROLINAS MEDICAL CENTERAtrium Health Myers Park - Medication Management Clinic1350 S. Kings DriveCharlotteNCActive
DSH340113CPChildDSHCAROLINAS MEDICAL CENTERADULT INTEGRATED CONTINUUM - Eagle Program501 Billingsley RoadCharlotteNCActive
DSH340113CQChildDSHCAROLINAS MEDICAL CENTERAtrium Health Neurosciences Institute - Epilepsy Clinic1225 Harding PlaceCharlotteNCActive
DSH340113CRChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute - Supportive Oncology101 WT Harris BlvdCharlotteNCActive
DSH340113CSChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute - Supportive Oncology1021 Morehead Medical DriveCharlotteNCActive
DSH340113CTChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute - Supportive Oncology10660 Park RoadCharlotteNCActive
DSH340113CUChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute - Surgical Oncology10660 Park RoadCharlotteNCActive
DSH340113CVChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute - Infusion Center16455 Statesville RdHuntersvilleNCActive
DSH340113CWChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute - Medical Oncology16455 Statesville RdHuntersvilleNCActive
DSH340113CXChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute - Endocrine Oncology10660 Park RoadCharlotteNCToBeTerminated
DSH340113CYChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute - Cutaneous/Plastics1021 Morehead Medical DriveCharlotteNCActive
DSH340113CZChildDSHCAROLINAS MEDICAL CENTERAtrium Health General & Complex Abdominal Surgery - CMC Trauma Clinic1025 Morehead Medical DriveCharlotteNCToBeTerminated
DSH340113DChildDSHCAROLINAS MEDICAL CENTERAtrium Health Myers Park Infectious Diseases Clinic1350 SOUTH KINGS DRIVECHARLOTTENCTerminated
DSH340113DAChildDSHCAROLINAS MEDICAL CENTERPediatric Outpatient Infusion Center CLIV1001 Blythe BlvdCharlotteNCActive
DSH340113DBChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute - Medical Oncology Clinic - Union1550 Faulk StreetMonroeNCActive
DSH340113DCChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute - Infusion Center - Union1550 Faulk StreetMonroeNCActive
DSH340113DDChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute - Infusion Center - Lincoln447 McAlister RoadLincolntonNCActive
DSH340113DEChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute - Medical Oncology Clinic - Lincoln447 McAlister RoadLincolntonNCActive
DSH340113DFChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute - Infusion Center - Cleveland201 East Grover StShelbyNCActive
DSH340113DGChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute - Medical Oncology Clinic - Cleveland201 East Grover StShelbyNCActive
DSH340113DHChildDSHCAROLINAS MEDICAL CENTERRadiation Oncology - Radiation Therapy and Brachytherapy1021 Morehead Medical DriveCharlotteNCActive
DSH340113DJChildDSHCAROLINAS MEDICAL CENTERAtrium Health Community Care Primary Care - Archdale Family Medicine5929 South BlvdCharlotteNCActive
DSH340113DKChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute - Surgical Oncology1100 Healing WayIndian TrailNCActive
DSH340113DLChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute - Supportive Oncology1100 Healing WayIndian TrailNCActive
DSH340113DMChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute - Infusion Center1100 Healing WayIndian TrailNCActive
DSH340113DNChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute - Medical Oncology1100 Healing WayIndian TrailNCActive
DSH340113DPChildDSHCAROLINAS MEDICAL CENTERLevine Cancer - CMC AYA Clinic1021 Morehead Medical DriveCharlotteNCActive
DSH340113DQChildDSHCAROLINAS MEDICAL CENTERMorehead Imaging Center - US1025 Morehead Medical DriveCharlotteNCActive
DSH340113DRChildDSHCAROLINAS MEDICAL CENTERLevine Cancer - Thoracic Clinic1021 Morehead Medical DriveCharlotteNCActive
DSH340113DSChildDSHCAROLINAS MEDICAL CENTERMorehead Imaging Center - NM1025 Morehead Medical DriveCharlotteNCActive
DSH340113DTChildDSHCAROLINAS MEDICAL CENTERMorehead Imaging Center - PET1025 Morehead Medical DriveCharlotteNCActive
DSH340113DUChildDSHCAROLINAS MEDICAL CENTERLevine Cancer - CMC Cancer Rehab Clinic1021 Morehead Medical DriveCharlotteNCActive
DSH340113DVChildDSHCAROLINAS MEDICAL CENTERLevine Cancer - Thoracic Cardiology Clinic1021 Morehead Medical DriveCharlotteNCActive
DSH340113DWChildDSHCAROLINAS MEDICAL CENTERMorehead Imaging Center - CT1025 Morehead Medical DriveCharlotteNCActive
DSH340113DXChildDSHCAROLINAS MEDICAL CENTERLevine Cancer - CMC Sexual Health1021 Morehead Medical DriveCharlotteNCActive
DSH340113DYChildDSHCAROLINAS MEDICAL CENTERAtrium Health Kenilworth - Kenilworth Infusion Center1225 Harding PlaceCharlotteNCActive
DSH340113DZChildDSHCAROLINAS MEDICAL CENTERMorehead Imaging Center - MR1025 Morehead Medical DriveCharlotteNCActive
DSH340113EChildDSHCAROLINAS MEDICAL CENTERAtrium Health Infusion Center1601 Abbey PlaceCharlotteNCActive
DSH340113EAChildDSHCAROLINAS MEDICAL CENTERMorehead Imaging Center - XR1025 Morehead Medical DriveCharlotteNCActive
DSH340113EBChildDSHCAROLINAS MEDICAL CENTERLevine Cancer - GI Clinic1021 Morehead Medical DriveCharlotteNCActive
DSH340113ECChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Infusion Center - Non-Oncology Infusion service line100 Medical Park DriveConcordNCActive
DSH340113FChildDSHCAROLINAS MEDICAL CENTERLevine Children's Specialty Center1001 Blythe BlvdCHARLOTTENCActive
DSH340113GChildDSHCAROLINAS MEDICAL CENTERCarolinas Diabetes Center1025 Morehead Medical DriveCharlotteNCTerminated
DSH340113HChildDSHCAROLINAS MEDICAL CENTERAtrium Health General & Complex Abdominal Surgery1025 Morehead Medical DriveCharlotteNCActive
DSH340113JChildDSHCAROLINAS MEDICAL CENTERAtrium Health Orthopedic Surgery1025 Morehead Medical DriveCharlotteNCActive
DSH340113KChildDSHCAROLINAS MEDICAL CENTERAtrium Health Dental Clinic1000 Blythe BlvdCharlotteNCActive
DSH340113LChildDSHCAROLINAS MEDICAL CENTERCMC Elizabeth Family Medicine2001 Vail AvenueCharlotteNCActive
DSH340113MChildDSHCAROLINAS MEDICAL CENTERAtrium Health Neurosciences Institute/MS Center, Sleep Center, and Sub-specialty Services1225 Harding PlaceCharlotteNCActive
DSH340113NChildDSHCAROLINAS MEDICAL CENTERAtrium Health One Day Surgery1001 Blythe BlvdCharlotteNCActive
DSH340113QChildDSHCAROLINAS MEDICAL CENTERAtrium Health Pain Management1025 Morehead Medical DriveCharlotteNCActive
DSH340113RChildDSHCAROLINAS MEDICAL CENTERLevine Children's Cancer & Blood Disorders1001 Blythe BlvdCharlotteNCActive
DSH340113SChildDSHCAROLINAS MEDICAL CENTERAdult Integrated Continuum501 Billingsley RoadCharlotteNCActive
DSH340113TChildDSHCAROLINAS MEDICAL CENTERCHS CMC Behavioral Health Child and Adolescent OP300 Billingsley RoadCharlotteNCTerminated
DSH340113UChildDSHCAROLINAS MEDICAL CENTERAtrium Health Behavioral Health Outpatient Medication Services Clinic501 Billingsley RoadCharlotteNCActive
DSH340113VChildDSHCAROLINAS MEDICAL CENTERAtrium Health Behavioral Health Observation Unit501 Billingsley RoadCharlotteNCActive
DSH340113WChildDSHCAROLINAS MEDICAL CENTERTeen Health Connection3541 Randolph RoadCharlotteNCActive
DSH340113XChildDSHCAROLINAS MEDICAL CENTERAtrium Health Fertility Center Morehead Medical Plaza1025 Morehead Medical DriveCharlotteNCActive
DSH340113YChildDSHCAROLINAS MEDICAL CENTERLevine Cancer Institute Blumenthal Infusion Center1021 Morehead Medical DriveCharlotteNCActive
DSH340113ZChildDSHCAROLINAS MEDICAL CENTERAtrium Health Transplant Center1025 Morehead Medical DriveCharlotteNCActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsPrimary ContactUpdateGroup Change RequestPaul-Aviles, Fern AVP, Pharmacy Atrium Health 7046499691Wishart, Bibi W Program Director, 340B North Carolina Baptist Hospital 33671334264/15/2025 11:06 AM
DetailsStateUpdate ApprovedActive10/1/2024 12:01 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestMabe, Don McCoy Chief Pharmacy Officer Atrium Health 7045127623Mabe, Don McCoy VP, Pharmacy Atrium Health 70451276238/13/2024 2:16 PM
ContactsSigned ByUpdateProfile Change RequestMabe, Don McCoy Chief Pharmacy Officer Atrium Health 7045127623Mabe, Don McCoy VP, Pharmacy Atrium Health 70451276238/13/2024 2:16 PM
ContactsSigned ByInsertNew Registration Mabe, Don McCoy Chief Pharmacy Officer Atrium Health 70451276237/23/2024 7:18 AM
Details340B IDUpdateNew Registration DSH340113DS7/23/2024 7:18 AM
DetailsEntity SubnameUpdateNew RegistrationMorehead Imaging CenterMorehead Imaging Center - NM7/23/2024 7:18 AM
DatesParticipating Approval DateUpdateNew Registration 7/23/2024 7:18:16 AM7/23/2024 7:18 AM
DetailsStateUpdateNew RegistrationPendingApproved7/23/2024 7:18 AM
DatesSigned By DateUpdateNew Registration 7/15/2024 3:05:02 PM7/23/2024 7:18 AM
DatesStart DateUpdateNew Registration 10/1/2024 12:00:00 AM7/23/2024 7:18 AM
AddressesMain AddressInsertNew Registration  1025 Morehead Medical Drive Suite 100 Charlotte, NC 282047/15/2024 2:47 PM
AddressesBilling AddressInsertNew Registration Atrium Health Accounts Payable PO Box 516 Elmsford, NY 105237/15/2024 2:47 PM
AddressesShipping AddressInsertNew Registration Morehead Imaging Center 1025 Morehead Medical Drive Suite 100 Charlotte, NC 282047/15/2024 2:47 PM
AddressesShipping AddressInsertNew Registration Carolinas Medical Center 1000 Blythe Blvd Pharmacy Charlotte, NC 282037/15/2024 2:47 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/15/2024 2:47 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 3366887/15/2024 2:47 PM
Medicaid BillingMedicaid: StateInsertNew Registration SC7/15/2024 2:47 PM
Medicaid BillingNPI: NumberInsertNew Registration 12957899077/15/2024 2:47 PM
Medicaid BillingNPI: StateInsertNew Registration NC7/15/2024 2:47 PM
Medicaid BillingNPI: NumberInsertNew Registration 12957899077/15/2024 2:47 PM
Medicaid BillingNPI: StateInsertNew Registration SC7/15/2024 2:47 PM
ContactsPrimary ContactInsertNew Registration Paul-Aviles, Fern AVP, Pharmacy Atrium Health 70464996917/15/2024 2:47 PM
ContactsAuthorizing OfficialInsertNew Registration Mabe, Don McCoy Chief Pharmacy Officer Atrium Health 70451276237/15/2024 2:47 PM
DetailsAssistance Received From DateInsertNew Registration  7/15/2024 2:47 PM
DetailsAssistance Received To DateInsertNew Registration  7/15/2024 2:47 PM
DetailsLast Recertification DateInsertNew Registration  7/15/2024 2:47 PM
DetailsGrant NumberInsertNew Registration  7/15/2024 2:47 PM
Details340B IDInsertNew Registration  7/15/2024 2:47 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  7/15/2024 2:47 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  7/15/2024 2:47 PM
DetailsMedicare Provider NumberInsertNew Registration 3401137/15/2024 2:47 PM
DetailsEntity NameInsertNew Registration CAROLINAS MEDICAL CENTER7/15/2024 2:47 PM
DetailsNOFO NumberInsertNew Registration  7/15/2024 2:47 PM
DetailsProgram CodeInsertNew Registration DSH7/15/2024 2:47 PM
DetailsEntity SubnameInsertNew Registration Morehead Imaging Center7/15/2024 2:47 PM
DatesParticipating Approval DateInsertNew Registration  7/15/2024 2:47 PM
DetailsStateInsertNew Registration Pending7/15/2024 2:47 PM
DatesRegistration DateInsertNew Registration 7/15/2024 2:47:47 PM7/15/2024 2:47 PM
DatesSigned By DateInsertNew Registration  7/15/2024 2:47 PM
DatesStart DateInsertNew Registration  7/15/2024 2:47 PM
TerminationsTermination CommentsInsertNew Registration  7/15/2024 2:47 PM
TerminationsTermination DateInsertNew Registration  7/15/2024 2:47 PM
TerminationsTermination Effective DateInsertNew Registration  7/15/2024 2:47 PM
TerminationsTermination ReasonInsertNew Registration  7/15/2024 2:47 PM