Covered Entity Details

DSH340091E THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION (Active) - information as of 5/3/2025 11:27:56 PM

Main Details

Name

THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION

Subdivision Name

Cone Health Cancer Center at Annie Penn

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH340091E

Medicare Provider Number

340091

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

3/2/2006

Participating Start Date

4/1/2006

Participating Approval Date

3/2/2006

Last Recertification Date

8/30/2024

Contacts

Authorizing Official

Cone Health
Andrew Barrow, Chief Financial Officer
(336) 832-7825

Primary Contact

Cone Health
Alex Kidd, Pharmacy Business Manager
(336) 890-3625

Addresses

Street Address

618 SOUTH MAIN STREET
REIDSVILLE, NC 27320

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	3400091	1477591055,1265589097,1295848562

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
DSH340091A	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Cone Health Family Medicine Center	1125 NORTH CHURCH STREET	GREENSBORO	NC	Active
DSH340091AA	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Moses Cone Surgery Center	1127 North Church Street	Greensboro	NC	Active
DSH340091AB	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Cone Health Patient Care Center	509 North Elam Avenue	Greensboro	NC	Active
DSH340091AC	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Outpatient Rehab Unit	1200 North Elm Street	Greensboro	NC	Terminated
DSH340091AD	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Cone Health Sports Medicine	1131-C North Church Street	Greensboro	NC	Active
DSH340091AE	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Cone Health Cardiovascular Imaging	1126 North Church Street	Greensboro	NC	Active
DSH340091AF	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Cone Health Cancer Center at MedCenter High Point	2630 WILLARD DAIRY RD #300	HIGH POINT	NC	Active
DSH340091AG	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH SPORTS MEDICINE AT MEDCENTER HIGH POINT	2630 WILLARD DAIRY ROAD	HIGH POINT	NC	Active
DSH340091AH	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Center For Women's Healthcare at Elam Avenue	520 North Elam Avenue	Greensboro	NC	Terminated
DSH340091AJ	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Annie Penn Hospital Emergency Department	618 South Main Street	Reidsville	NC	Active
DSH340091AK	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Wesley Long Hospital Emergency Department	2400 W. Friendly Ave	Greensboro	NC	Active
DSH340091AL	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH CARDIOVASCULAR IMAGING	3200 NORTHLINE AVE	GREENSBORO	NC	Active
DSH340091AM	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH COMMUNITY HEALTH AND WELLNESS	301 E WENDOVER AVE	GREENSBORO	NC	Active
DSH340091AN	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	MedCenter High Point / Radiology	2630 Willard Dairy Road	High Point	NC	Terminated
DSH340091AP	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	MedCenter High Point / Ultrasound	2630 Willard Dairy Road	High Point	NC	Terminated
DSH340091AQ	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	MedCenter High Point / Mammogram	2630 Willard Dairy Road	High Point	NC	Terminated
DSH340091AR	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	MedCenter High Point / Nuclear Medicine	2630 Willard Dairy Road	High Point	NC	Terminated
DSH340091AS	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	MedCenter High Point / CT Scan	2630 Willard Dairy Road	High Point	NC	Terminated
DSH340091AT	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	MedCenter High Point / MRI	2630 Willard Dairy Road	High Point	NC	Terminated
DSH340091AU	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH-Women's and Children's Center at Moses Cone Hospital / Maternity Admissions	1200 North Elm Street	GREENSBORO	NC	Active
DSH340091AV	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	ANNIE PENN HOSPITAL / Medical Day	618 South Main Street	Reidsville	NC	Active
DSH340091AW	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	WESLEY LONG HOSPITAL / Perioperative Service	2400 W. Friendly Ave	Greensboro	NC	Active
DSH340091AX	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	ANNIE PENN HOSPITAL / MRI	618 South Main Street	Reidsville	NC	Active
DSH340091AY	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	WESLEY LONG HOSPITAL / MRI	2400 W. Friendly Ave	Greensboro	NC	Active
DSH340091AZ	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH - WOMEN'S HOSPITAL / OR	801 GREEN VALLEY ROAD	GREENSBORO	NC	Terminated
DSH340091BA	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	ANNIE PENN HOSPITAL / CT Scan	618 South Main Street	Reidsville	NC	Active
DSH340091BB	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Wesley Long Hospital / CT Scan	2400 W. Friendly Ave	Greensboro	NC	Active
DSH340091BC	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH - WOMEN'S HOSPITAL / CT Scan	801 Green Valley Road	Greensboro	NC	Terminated
DSH340091BD	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Cone Health Cancer Center at Wesley Long / Radiation Oncology	2400 W. Friendly Ave	Greensboro	NC	Active
DSH340091BE	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Wesley Long Hospital / Nuclear Medicine	2400 W. Friendly Ave	Greensboro	NC	Active
DSH340091BF	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	ANNIE PENN HOSPITAL / Radiology Diagnostic	618 SOUTH MAIN STREET	REIDSVILLE	NC	Active
DSH340091BG	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	WESLEY LONG HOSPITAL / OR	2400 W. FRIENDLY AVE	GREENSBORO	NC	Active
DSH340091BH	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	WESLEY LONG HOSPITAL / Radiology Diagnostic	2400 W. FRIENDLY AVE	GREENSBORO	NC	Active
DSH340091BJ	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH - WOMEN'S HOSPITAL \ Radiology Diagnostic	801 GREEN VALLEY ROAD	GREENSBORO	NC	Terminated
DSH340091BK	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	ANNIE PENN HOSPITAL / OR	618 SOUTH MAIN STREET	REIDSVILLE	NC	Active
DSH340091BL	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Wesley Long Hospital Endoscopy - Endoscopy	2400 West Friendly Avenue	Greensboro	NC	Active
DSH340091BM	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH OUTPATIENT ORTHOPEDIC AND PEDIATRIC REHABILITATION - REHABILITATION	1904 North Church Street	Greensboro	NC	Terminated
DSH340091BN	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH OUTPATIENT CANCER REHABILITATION CENTER - REHABILITATION	1904 North Church Street	Greensboro	NC	Terminated
DSH340091BP	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH OUTPATIENT REHAB CENTER AT MEDCENTER HIGH POINT - REHABILITATION	2630 Willard Dairy Road, Suite 201	High Point	NC	Terminated
DSH340091BQ	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Annie Penn Hospital Endoscopy - Endoscopy	618 South Main Street	Reidsville	NC	Active
DSH340091BR	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Cone Health Cancer Center at Wesley Long - Gynecology Oncology	2400 West Friendly Avenue	Greensboro	NC	Active
DSH340091BS	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Center for Maternal Fetal Care at Cone Health Medcenter for Women	930 Third Street	Greensboro	NC	Active
DSH340091BT	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Annie Penn Hospital/Nuclear Medicine - Nuclear Medicine	618 South Main Street	Reidsville	NC	Active
DSH340091BU	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH - GUILFORD COUNTY BEHAV - Urgent Care	931 3RD ST	GREENSBORO	NC	Active
DSH340091BV	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	MEDCTR GREENSBORO AT DRAWBRIDGE ED - Emergency Department	3518 DRAWBRIDGE PKWY STE 010	GREENSBORO	NC	Active
DSH340091BW	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH CANCER CENTER ASHEBORO - Oncology	1319 Spero Road	ASHEBORO	NC	Active
DSH340091BX	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Cone Health Cancer Center at Drawbridge - Oncology	3518 Drawbridge Parkway	Greensboro	NC	Active
DSH340091BY	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH HEARTCARE AT ASHEBORO - Heart Care	542 WHITE OAK ST	ASHEBORO	NC	Active
DSH340091BZ	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH HEARTCARE AT CHURCH ST - Heart Care	1126 N CHURCH ST	GREENSBORO	NC	Active
DSH340091CA	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH CANCER CTR AT ALAMANCE - Radiation Oncology	1236 HUFFMAN MILL RD	BURLINGTON	NC	Active
DSH340091CB	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH HEARTCARE AT ANNIE PENN - Heart Care	618 S MAIN ST	REIDSVILLE	NC	Active
DSH340091CC	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH HEARTCARE AT NORTHLINE - Heart Care	3200 NORTHLINE AVE	GREENSBORO	NC	Active
DSH340091CD	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH HEARTCARE AT EDEN - Heart Care	110 S PARK TER	EDEN	NC	Active
DSH340091CE	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH HEARTCARE AT BURLINGTON - Heart Care	1236 HUFFMAN MILL RD	BURLINGTON	NC	Active
DSH340091CF	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH HEARTCARE AT HIGH PT - Heart Care	2630 WILLARD DAIRY RD	HIGH POINT	NC	Active
DSH340091CG	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH RHEUMATOLOGY - Rheumatology	1313 CAROLINA ST	GREENSBORO	NC	Active
DSH340091CH	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH CANCER CTR AT ALAMANCE - Medical Oncology	1236 HUFFMAN MILL RD	BURLINGTON	NC	Active
DSH340091CJ	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Annie Penn Hospital - Cardio-Pulmonary	618 South Main Street	Reidsville	NC	Active
DSH340091CK	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Annie Penn Hospital - Respiratory Therapy	618 South Main Street	Reidsville	NC	Active
DSH340091CL	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Wesley Long Hospital - Respiratory Therapy	2400 W. Friendly Avenue	Greensboro	NC	Active
DSH340091D	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Cone Health Cancer Center at Wesley Long	2400 W. Friendly Ave	GREENSBORO	NC	Active
DSH340091E	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Cone Health Cancer Center at Annie Penn	618 SOUTH MAIN STREET	REIDSVILLE	NC	Active
DSH340091I	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	NUTRITION AND DIABETES EDUCATION SERVICES AT GREENSBORO	301 E. WENDOVER AVENUE, SUITE 415	GREENSBORO	NC	Terminated
DSH340091J	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH PHYSICAL MEDICINE AND REHABILITATION	1126 North Church Street	GREENSBORO	NC	Active
DSH340091K	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH WOUND CARE AND HYPERBARIC CENTER	509 NORTH ELAM AVENUE	GREENSBORO	NC	Terminated
DSH340091L	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	CONE HEALTH-Women's and Children's Center at Moses Cone Hospital	1200 North Elm Street	GREENSBORO	NC	Active
DSH340091M	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	WESLEY LONG HOSPITAL	2400 W. Friendly Ave	GREENSBORO	NC	Active
DSH340091N	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	ANNIE PENN HOSPITAL	618 SOUTH MAIN STREET	REIDSVILLE	NC	Active
DSH340091P	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	MEDCENTER HIGH POINT EMERGENCY DEPARTMENT	2630 WILLARD DAIRY ROAD	HIGH POINT	NC	Active
DSH340091Q	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Sleep Disorders Center at Wesley Long	509 North Elam Avenue	Greensboro	NC	Terminated
DSH340091R	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Regional Center for Infectious Disease	301 East Wendover Avenue	Greensboro	NC	Active
DSH340091T	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Cone Health Neurorehabilitation Center	912 Third Street	Greensboro	NC	Terminated
DSH340091U	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Cone Health Outpatient Rehab Center at Brassfield	3800 Robert Porcher Way	Greensboro	NC	Terminated
DSH340091V	Child	DSH	The Moses H Cone Memorial Hospital Operating Corporation	Outpatient Rehabilitation Center at Guilford College	603 Dolley Madison Road	Greensboro	NC	Terminated
DSH340091W	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Cone Health Outpatient Rehab Center at Madison	401A West Decatur Street	Madison	NC	Terminated
DSH340091X	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Cone Health Outpatient Rehab Center at Adams Farm	5817 WEST GATE CITY BOULEVARD	Greensboro	NC	Terminated
DSH340091Y	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Cone Health Outpatient Rehabilitation Center	1904 North Church Street	Greensboro	NC	Terminated
DSH340091Z	Child	DSH	THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	Wesley Long Surgery Center	509 North Elam Avenue	Greensboro	NC	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/29/2023 3:59:39 PM	8/30/2024 10:17:39 AM	8/30/2024 10:17 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1295848562	5/31/2024 4:41 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		NC	5/31/2024 4:41 PM
Contacts	Primary Contact	Update	Profile Change Request	Kidd, Alex Pharmacy Business Manager Cone Health 3368322124	Kidd, Alex Pharmacy Business Manager Cone Health 3368903625	4/16/2024 2:16 PM
Details	Last Recertification Date	Update	Recertification	9/6/2022 10:27:30 AM	8/29/2023 3:59:39 PM	8/29/2023 3:59 PM
Details	Last Recertification Date	Update	Recertification	8/31/2021 12:39:52 PM	9/6/2022 10:27:30 AM	9/6/2022 10:27 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	000499012X (GA)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	403163 (SC)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1477591055 (VA)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	02204451 (NY)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	418679600 (MD)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	097584200 (FL)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	032067300 (DC)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	4172701 (NJ)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	2999573 (OH)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1477591055 (CA)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1477591055 (MI)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	072533502 (TX)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1477591055 (WV)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	01520634 (KY)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	003050515 (CT)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	0340091 (TN)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	581588823001 (IL)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	752548221 (AL)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1477591055 (WA)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1477591055 (IA)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	200913450A (IN)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1477591055 (MN)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1477591055 (ID)		8/31/2021 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1477591055 (SD)		8/31/2021 12:39 PM
Details	Last Recertification Date	Update	Recertification	8/28/2020 9:23:23 AM	8/31/2021 12:39:52 PM	8/31/2021 12:39 PM
Contacts	Authorizing Official	Update	AO Change Request	Jones, Jeffrey Executive VP and CFO Cone Health 3368328005	Barrow, Andrew Chief Financial Officer Cone Health 3368327825	3/8/2021 2:36 PM
Medicaid Billing	NPI: State	Update	Recertification		NC	8/28/2020 9:23 AM
Medicaid Billing	NPI: State	Update	Recertification		NC	8/28/2020 9:23 AM
Details	Last Recertification Date	Update	Recertification	9/9/2019 7:10:22 AM	8/28/2020 9:23:23 AM	8/28/2020 9:23 AM
Details	Last Recertification Date	Update	Recertification	8/31/2018 11:28:34 AM	9/9/2019 7:10:22 AM	9/9/2019 7:10 AM
Details	Last Recertification Date	Update	Recertification	11/14/2017 1:28:58 PM	8/31/2018 11:28:34 AM	8/31/2018 11:28 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1265589097	4/20/2018 4:01 PM
Details	Last Recertification Date	Update	Recertification	8/22/2016 12:00:00 AM	11/14/2017 1:28:58 PM	11/14/2017 1:28 PM
Contacts	Authorizing Official	Update		Jones, Jeffrey Executive VP and CFO 3368328005	Jones, Jeffrey Executive VP and CFO Cone Health 3368328005	10/2/2017 3:13 PM
Contacts	Primary Contact	Update		Kidd, Alex Pharmacy Business Manager 3368322124	Kidd, Alex Pharmacy Business Manager Cone Health 3368322124	9/20/2017 1:22 PM
Contacts	Authorizing Official	Insert			Jones, Jeffrey Executive VP and CFO 3368328005	8/3/2017 8:07 AM
Contacts	Primary Contact	Insert			Kidd, Alex Pharmacy Business Manager 3368322124	8/2/2017 10:13 AM
Addresses	Main Address	Insert			618 SOUTH MAIN STREET REIDSVILLE, NC 27320	4/25/2017 2:46 PM
Details	Last Recertification Date	Update		8/12/2015 12:00:00 AM	8/22/2016 12:00:00 AM	8/22/2016 2:25 PM
Details	Entity Subname	Update		ANNIE PENN CANCER CENTER	Cone Health Cancer Center at Annie Penn	1/22/2016 4:12 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			02204451	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			NY	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			418679600	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			MD	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			097584200	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			FL	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			032067300	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			DC	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			4172701	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			NJ	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			2999573	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			OH	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			1477591055	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			CA	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			1477591055	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			MI	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			072533502	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			TX	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			1477591055	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			WV	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			01520634	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			KY	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			003050515	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			CT	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			0340091	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			TN	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			581588823001	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			IL	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			752548221	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			AL	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			1477591055	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			WA	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			1477591055	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			IA	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			200913450A	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			IN	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			1477591055	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			MN	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			1477591055	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			ID	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Number	Insert			1477591055	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: State	Insert			SD	11/20/2015 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/12/2015 1:37 PM
Details	Last Recertification Date	Update		8/21/2014 12:00:00 AM	8/12/2015 12:00:00 AM	8/12/2015 1:37 PM
Details	Last Recertification Date	Update		8/30/2013 12:00:00 AM	8/21/2014 12:00:00 AM	8/21/2014 3:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/21/2014 9:31 AM
Medicaid Billing	Medicaid: Number	Insert			000499012X	1/21/2014 9:31 AM
Medicaid Billing	Medicaid: State	Insert			GA	1/21/2014 9:31 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/21/2014 9:31 AM
Medicaid Billing	Medicaid: Number	Insert			403163	1/21/2014 9:31 AM
Medicaid Billing	Medicaid: State	Insert			SC	1/21/2014 9:31 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/21/2014 9:31 AM
Medicaid Billing	Medicaid: Number	Insert			1477591055	1/21/2014 9:31 AM
Medicaid Billing	Medicaid: State	Insert			VA	1/21/2014 9:31 AM
Medicaid Billing	NPI: Number	Insert			1477591055	1/21/2014 9:31 AM
Details	Last Recertification Date	Update		8/30/2013 1:07:23 PM	8/30/2013 12:00:00 AM	1/21/2014 9:31 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/30/2013 1:07:23 PM	8/30/2013 1:07 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/14/2012 8:53 AM
Medicaid Billing	Medicaid: Is Primary	Insert			True	3/2/2006 7:10 AM
Medicaid Billing	Medicaid: Number	Insert			3400091	3/2/2006 7:10 AM
Medicaid Billing	Medicaid: State	Insert			NC	3/2/2006 7:10 AM
Details	Last Recertification Date	Insert				3/2/2006 7:10 AM
Details	Grant Number	Insert				3/2/2006 7:10 AM
Details	340B ID	Insert			DSH340091E	3/2/2006 7:10 AM
Details	Is Authorizing Official EHB Data	Insert				3/2/2006 7:10 AM
Dates	Last Date That 340B Drugs Purchased	Insert				3/2/2006 7:10 AM
Details	Medicare Provider Number	Insert			340091	3/2/2006 7:10 AM
Details	Entity Name	Insert			THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION	3/2/2006 7:10 AM
Details	Program Code	Insert			DSH	3/2/2006 7:10 AM
Details	Entity Subname	Insert			ANNIE PENN CANCER CENTER	3/2/2006 7:10 AM
Dates	Participating Approval Date	Insert			3/2/2006 12:00:00 AM	3/2/2006 7:10 AM
Details	State	Insert			Active	3/2/2006 7:10 AM
Dates	Registration Date	Insert			3/2/2006 12:00:00 AM	3/2/2006 7:10 AM
Dates	Signed By Date	Insert			2/22/2006 12:00:00 AM	3/2/2006 7:10 AM
Dates	Start Date	Insert			4/1/2006 12:00:00 AM	3/2/2006 7:10 AM
Terminations	Termination Comments	Insert				3/2/2006 7:10 AM
Terminations	Termination Date	Insert				3/2/2006 7:10 AM
Terminations	Termination Effective Date	Insert				3/2/2006 7:10 AM
Terminations	Termination Reason	Insert				3/2/2006 7:10 AM