Covered Entity Details

DSH340053 Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center (Active) - information as of 4/27/2025 12:51:24 AM

Main Details

Name

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

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH340053

Medicare Provider Number

340053

Additional Details

Current Program Status

Active

Registration Date

2/26/2008

Participating Start Date

4/1/2008

Participating Approval Date

2/27/2008

Last Recertification Date

8/23/2024

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

200 HAWTHORNE LANE
CHARLOTTE, NC 28204

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
10/28/10 NPI # REVISED (WAS 340003)	10/28/2010

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
FL	92642600
MD	546255000
NC		1881647204,1174062970,1497708838,1366585200,1245841279
SC		1881647204
VA		1881647204

Shipping Addresses

Shipping Address 1

The Presbyterian Hospital DBA Novant Health Pharmacy
8401 University Exec Park Dr
127
Charlotte, NC 28262-3330

Shipping Address 2

The Presbyterian Hospital DBA Novant Health Pharmacy
125 Queens Rd
180
Charlotte, NC 28204-3215

Shipping Address 3

Safecor Health
4060 Business Park Drive
Columbus, OH 43204

Shipping Address 4

The Presbyterian Hospital DBA Home Delivery Pharmacy
4601 Corporate Dr. NW
Concord, NC 28027-9659

Shipping Address 5

Novant Health Pharmacy at Presbyterian Medical Center
200 Hawthorne Lane
Charlotte, NC 28204

Shipping Address 6

Unit Dose Solutions, Inc.
860 Aviation Pkwy
#400
Morrisville, NC 27560

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	01/18/2021	04/01/2021		04/01/2021
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	01/18/2021	04/01/2021		04/01/2021
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	01/18/2021	04/01/2021		04/01/2021
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	01/18/2021	04/01/2021		04/01/2021
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	01/18/2021	04/01/2021		04/01/2021
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	01/18/2021	04/01/2021	08/21/2023	03/14/2024
Contract Detail	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/19/2024	07/01/2024		07/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	01/15/2024	04/01/2024		04/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	01/15/2024	04/01/2024		04/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	01/15/2024	04/01/2024		04/01/2024
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/24/2023	04/01/2023		04/01/2023
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/24/2023	04/01/2023		04/01/2023
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/24/2023	04/01/2023		04/01/2023
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/24/2023	04/01/2023		04/01/2023
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/24/2023	04/01/2023		04/01/2023
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/24/2023	04/01/2023		04/01/2023
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/24/2023	04/01/2023		04/01/2023
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/24/2023	04/01/2023		04/01/2023
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/24/2023	04/01/2023		04/01/2023
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/24/2023	04/01/2023		04/01/2023
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/24/2023	04/01/2023		04/01/2023
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/24/2023	04/01/2023		04/01/2023
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/24/2023	04/01/2023		04/01/2023
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	10/13/2020	01/01/2021		01/01/2021
Contract Detail	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	01/15/2024	04/01/2024		04/01/2024
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	01/18/2021	04/01/2021		04/01/2021
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	01/18/2021	04/01/2021		04/01/2021
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	01/18/2021	04/01/2021		04/01/2021
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	01/18/2021	04/01/2021		04/01/2021
Contract Detail	FORSYTH MEMORIAL HOSPITAL	DBA NOVANT HEALTH PHARMACY	3333 SILAS CREEK PKWY	WINSTON SALEM	NC	27103-3013	10/28/2016	01/01/2017	04/01/2021	11/09/2021
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17215	12830 WALKER BRANCH RD	CHARLOTTE	NC	28273	01/23/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07054	4300 NC HWY 49 S	HARRISBURG	NC	28075	01/23/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05264	6428 REA ROAD	CHARLOTTE	NC	28277	01/23/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03540	4391 CENTRAL AVE.	CHARLOTTE	NC	28205	01/23/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02233	6750 WILKINSON BLVD.	BELMONT	NC	28012	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16374	9801 SAM FURR RD	HUNTERSVILLE	NC	28078	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #11441	610 S. CALDWELL STREET, UNIT 101	CHARLOTTE	NC	28202	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06402	127 S. MAIN ST.	DAVIDSON	NC	28036	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03526	306 EAST WOODLAWN RD	CHARLOTTE	NC	28217	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16916	8830 ALBEMARLE RD	CHARLOTTE	NC	28227	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01674	16715 OLD STATESVILLE RD.	HUNTERSVILLE	NC	28078	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07407	6110 THE PLAZA	CHARLOTTE	NC	28215	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07688	3440 WILKINSON BOULEVARD	CHARLOTTE	NC	28208	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06406	3126 DALLAS-HIGH SHOALS HWY.	DALLAS	NC	28034	01/24/2023	04/01/2023	11/06/2023	11/06/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00187	14125 STEELE CREEK RD.	CHARLOTTE	NC	28273	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07090	16035 JOHNSTON RD.	CHARLOTTE	NC	28277	01/24/2023	04/01/2023	08/04/2023	08/09/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04620	7409 WEBBS RD.,	DENVER	NC	28037	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17162	2901 W HIGHWAY 74	MONROE	NC	28110	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16342	1900 MATTHEWS TOWNSHIP PKWY	MATTHEWS	NC	28105	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16461	8120 UNIVERSITY CITY BLVD	CHARLOTTE	NC	28213	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07524	101 E. MAIN ST.	LOCUST	NC	28097	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02314	19305 W. CATAWBA AVE. PO BOX 1364	CORNELIUS	NC	28031	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07089	231 N. GRAHAM STREET	CHARLOTTE	NC	28202	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03185	1533 SOUTH BLVD	CHARLOTTE	NC	28203	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03837	1803 S. NEW HOPE ROAD	GASTONIA	NC	28054	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07213	3310 SISKEY PKWY.	MATTHEWS	NC	28105	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01742	2901 WESLEY CHAPEL STOUTS RD.	MONROE	NC	28110	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07056	2115 BEATTIES FORD RD	CHARLOTTE	NC	28216	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02560	2035 NORTH SHARON AMITY RD	CHARLOTTE	NC	28205	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03514	442 HIGHWAY 27 SOUTH	STANLEY	NC	28164	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03806	1403 E. MAIN ST.	LINCOLNTON	NC	28092	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01632	9628 REA RD.	CHARLOTTE	NC	28277	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02559	10515 MALLARD CREEK ROAD	CHARLOTTE	NC	28262	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03896	9308 KENDALL DR.	CHARLOTTE	NC	28214	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17458	6350 WEDDINGTON RD	WESLEY CHAPEL	NC	28104	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01737	6300 MONROE WEDDINGTON RD.	MATTHEWS	NC	28104	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06518	11430 N TRYON ST	CHARLOTTE	NC	28262	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05588	6050 SOUTH NC 16 BUSINESS HWY	DENVER	NC	28037	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17168	9841 NORTHLAKE CENTRE PKWY	CHARLOTTE	NC	28216	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07566	8765 HWY 52	ROCKWELL	NC	28138	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16466	7860 REA RD	CHARLOTTE	NC	28277	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04299	1305 MATTHEWS TOWNSHIP PKWY	MATTHEWS	NC	28105	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03815	1156 E. CASWELL STREET	WADESBORO	NC	28170	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07578	3658 SOUTH NEW HOPE RD.	GASTONIA	NC	28056	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07157	13845 CONLAN CIRCLE	CHARLOTTE	NC	28277	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07941	8420 STEELE CREEK RD.	CHARLOTTE	NC	28273	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17249	6150 BAYFIELD PKWY	CONCORD	NC	28027	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02571	1235 PECAN AVE.,	CHARLOTTE	NC	28205	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02562	115 W. ARROWOOD RD.	CHARLOTTE	NC	28217	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08260	8220 MOUNT HOLLY HUNTERSVILLE RD.	CHARLOTTE	NC	28216	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07943	8101 KENSINGTON DR.	WAXHAW	NC	28173	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03440	1602 PROVIDENCE RD., SOUTH	WAXHAW	NC	28173	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07492	3610 MATTHEWS MINT HILL ROAD	MATTHEWS	NC	28105	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02326	5700 ALBEMARLE ROAD	CHARLOTTE	NC	28212	01/24/2023	04/01/2023	06/08/2023	06/21/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01643	2002 SHILOH CHURCH RD.	DAVIDSON	NC	28036	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05565	1075 EAST HUDSON BLVD	GASTONIA	NC	28054	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17319	900 METROPOLITAN AVE STE 2	CHARLOTTE	NC	28204	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07564	625 E. ROOSEVELT BOULEVARD	MONROE	NC	28112	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02561	4100 CARMEL ROAD	CHARLOTTE	NC	28226	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS/PHARMACY #10574	4908 HOUSTON FIELD COURT	CHARLOTTE	NC	28277	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02563	9931 GILEAD RD	HUNTERSVILLE	NC	28078	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03523	274 NORTH MAIN STREET	MOORESVILLE	NC	28115	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04022	210 E. TRADE ST., STE. E-186	CHARLOTTE	NC	28202	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00162	10012 WEISS WAY	WAXHAW	NC	28173	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07539	1924 STATESVILLE BLVD.	SALISBURY	NC	28144	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07573	6713 EAST MARSHVILLE BLVD.	MARSHVILLE	NC	28103	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04098	4300 OLD MONROE ROAD	INDIAN TRAIL	NC	28079	01/24/2023	04/01/2023	04/04/2023	04/07/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05463	9805 ROCKY RIVER RD.	CHARLOTTE	NC	28215	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02772	10730 PROVIDENCE RD.	CHARLOTTE	NC	28277	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03319	9915 PARK CEDAR DR	CHARLOTTE	NC	28210	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05445	5100 BEATTIES FORD RD.	CHARLOTTE	NC	28216	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02357	7920 SAM FURR ROAD	HUNTERSVILLE	NC	28078	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03803	559 RIVER HWY	MOORESVILLE	NC	28117	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04490	2580 COURT DRIVE	GASTONIA	NC	28054	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02877	14600 LAWYERS RD.	MATTHEWS	NC	28104	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17178	9870 REA RD	CHARLOTTE	NC	28277	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05341	1142 N. BROOME ST.	WAXHAW	NC	28173	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03694	2325 VILLAGE LAKE DR.	CHARLOTTE	NC	28212	01/24/2023	04/01/2023	12/13/2023	01/02/2024
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05583	2939 THE PLAZA	CHARLOTTE	NC	28205	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03593	2501 W. ROOSEVELT BLVD.	MONROE	NC	28110	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07536	4307 WILGROVE-MINT HILL RD.	MINT HILL	NC	28227	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #3813	835 NC 24 27 BYP E	ALBEMARLE	NC	28001-5359	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03435	1260 UNION ST S	CONCORD	NC	28025-5810	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02749	5225 POPLAR TENT RD	CONCORD	NC	28027	01/24/2023	04/01/2023		04/01/2023
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03823	1850 WEST FRANKLIN BOULEVARD	GASTONIA	NC	28052	10/16/2023	01/01/2024		01/01/2024
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07512	4553 MAIN STREET	SHALLOTTE	NC	28470	07/12/2024	10/01/2024		10/01/2024
Contract Detail	NOVANT HEALTH PHARMACY SERVICES LLC	DBA: NOVANT HEALTH PHARMACY	200 HAWTHORNE ROAD	CHARLOTTE	NC	28204	10/28/2016	01/01/2017	12/11/2019	12/12/2019
Contract Detail	NOVANT HEALTH PHARMACY SERVICES LLC	DBA NOVANT HEALTH PHARMACY	255 CHARLOIS BLVD	WINSTON-SALEM	NC	27103	10/28/2016	01/01/2017	12/11/2019	12/12/2019
Contract Detail	NOVANT HEALTH PHARMACY SERVICES LLC	DBA NOVANT HEALTH PHARMACY	8401 UNIVERSITY EXEC PARK DR STE 127	CHARLOTTE	NC	28262-3330	10/14/2019	01/01/2020	04/01/2021	11/09/2021
Contract Detail	NOVANT HEALTH THOMASVILLE MEDICAL CENTER	DBA NOVANT HEALTH SPECIALTY PHARMACY	1381 WESTGATE CENTER DR	WINSTON SALEM	NC	27103	10/28/2016	01/01/2017	04/01/2021	11/09/2021
Contract Detail	OPTUM INFUSION SERVICES 550, LLC	20 COMMERCE WAY	SUITE 2	WOBURN	MA	01801	07/12/2024	10/01/2024		10/01/2024
Contract Detail	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	07/12/2024	10/01/2024		10/01/2024
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	07/12/2024	10/01/2024		10/01/2024
Contract Detail	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	07/12/2024	10/01/2024		10/01/2024
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	07/12/2024	10/01/2024		10/01/2024
Contract Detail	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	07/12/2024	10/01/2024		10/01/2024
Contract Detail	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	07/12/2024	10/01/2024		10/01/2024
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	07/12/2024	10/01/2024		10/01/2024
Contract Detail	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	07/12/2024	10/01/2024		10/01/2024
Contract Detail	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	07/12/2024	10/01/2024		10/01/2024
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	07/12/2024	10/01/2024		10/01/2024
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	07/12/2024	10/01/2024		10/01/2024
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	10/13/2020	01/01/2021	10/01/2022	10/14/2022
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/24/2023	04/01/2023		04/01/2023
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	01/24/2023	04/01/2023		04/01/2023
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/24/2023	04/01/2023		04/01/2023
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/24/2023	04/01/2023		04/01/2023
Contract Detail	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	01/15/2024	04/01/2024		04/01/2024
Contract Detail	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	01/15/2024	04/01/2024		04/01/2024
Contract Detail	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	01/15/2024	04/01/2024	03/19/2024	03/19/2024
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07005	333 HWY 9 BYPASS	LANCASTER	SC	29720	01/24/2023	04/01/2023		04/01/2023
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05541	205 N. VAN LINGLE MUNGO BLVD.	PAGELAND	SC	29728	01/24/2023	04/01/2023		04/01/2023
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01571	1740 HWY 160 WEST	FORT MILL	SC	29708	01/24/2023	04/01/2023		04/01/2023
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07036	690 BETHEL ST.	CLOVER	SC	29710	01/24/2023	04/01/2023		04/01/2023
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05479	7697 CHARLOTTE HWY.	INDIAN LAND	SC	29707	01/24/2023	04/01/2023		04/01/2023
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05550	4724 CHARLOTTE HWY.	CLOVER	SC	29710	01/24/2023	04/01/2023		04/01/2023
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04288	2707 CELANESE RD.	ROCK HILL	SC	29732	01/24/2023	04/01/2023		04/01/2023
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04287	510 TOM HALL ST.	FORT MILL	SC	29715	01/24/2023	04/01/2023		04/01/2023
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	D/B/A CVS/PHARMACY #10787	1919 SPRINGFIELD PKWY	FORT MILL	SC	29715	01/24/2023	04/01/2023		04/01/2023
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05679	1746 HECKLE BLVD	ROCK HILL	SC	29732	01/24/2023	04/01/2023		04/01/2023
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03809	609 CHERRY RD.	ROCK HILL	SC	29732	01/24/2023	04/01/2023		04/01/2023
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16710	1900 SPRINGSTEEN RD	ROCK HILL	SC	29730	01/24/2023	04/01/2023		04/01/2023
Contract Detail	THE PRESBYTERIAN HOSPITAL	DBA NOVANT HEALTH PHARMACY	125 QUEENS RD STE 180	CHARLOTTE	NC	28204	10/13/2020	01/01/2021	01/01/2021	02/25/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 01376	6649 CARNEGIE BLVD	CHARLOTTE	NC	28211	07/11/2019	10/01/2019		10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04546	3080 MILTON RD.	CHARLOTTE	NC	28215	07/11/2019	10/01/2019		10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04547	8538 N TRYON ST	CHARLOTTE	NC	28262	07/11/2019	10/01/2019		10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04548	6848 ALBEMARLE RD.	CHARLOTTE	NC	28212	07/11/2019	10/01/2019		10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04549	9202 LAWYERS RD.	MINT HILL	NC	28227	07/11/2019	10/01/2019		10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04869	3251 FREEDOM DR.	CHARLOTTE	NC	28208	07/11/2019	10/01/2019		10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05761	4701 SOUTH BLVD	CHARLOTTE	NC	28217	07/11/2019	10/01/2019		10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07342	7711 COLONY ROAD	CHARLOTTE	NC	28226	07/11/2019	10/01/2019		10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07400	16711 BIRKDALE COMMONS PKWY	HUNTERSVILLE	NC	28078-4412	07/11/2019	10/01/2019		10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07401	13720 HIGHWAY 74	INDIAN TRAIL	NC	28079-7600	07/11/2019	10/01/2019		10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07766	1510 SARDIS RD N	CHARLOTTE	NC	28270-1408	07/11/2019	10/01/2019		10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS #10275	5040 BEATTIES FORD RD.	CHARLOTTE	NC	28216-2835	07/11/2019	10/01/2019		10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS #10287	9848 GILEAD RD.	HUNTERSVILLE	NC	28078	07/11/2019	10/01/2019		10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11396	2200 W. SUGAR CREEK RD.	CHARLOTTE	NC	28262	07/11/2019	10/01/2019		10/01/2019
Contract Detail	WALGREEN CO.	DBA WALGREENS #15392	4625 HYLAS LANE	HUNTERSVILLE	NC	28078	07/11/2019	10/01/2019		10/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #18352	334 S SHARON AMITY RD	CHARLOTTE	NC	28211	07/11/2019	10/01/2019		10/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #21284	200 HAWTHORNE LN STE T1578	CHARLOTTE	NC	28204	12/20/2019	01/01/2020	01/22/2025	01/22/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS #13036	7385 NC 73 HIGHWAY	DENVER	NC	28037	07/13/2021	10/01/2021		10/01/2021
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16405	1500 E 3RD ST STE A	CHARLOTTE	NC	28204	07/13/2021	10/01/2021		10/01/2021
Contract Detail	WALGREEN CO.	WALGREENS #17368	617 HIGHLAND ST	MOUNT HOLLY	NC	28120	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	WALGREENS #18121	2400 LITTLE ROCK RD	CHARLOTTE	NC	28214	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04843	6802 W WILKINSON BLVD	BELMONT	NC	28012	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	WALGREENS #17073	4133 PARK RD	CHARLOTTE	NC	28209	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	WALGREENS #19654	544 PROVIDENCE RD	CHARLOTTE	NC	28207	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	WALGREENS #18053	6231 FAIRVIEW RD	CHARLOTTE	NC	28210	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	WALGREENS #17014	3534 MT HOLLY-HUNTERSVILLE RD	CHARLOTTE	NC	28216	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06480	2800 W MALLARD CREEK CHURCH RD	CHARLOTTE	NC	28262	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #10154	6028 S. NC 16 HWY.	MAIDEN	NC	28650	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	WALGREENS #19646	7115 E W. T. HARRIS BLVD	CHARLOTTE	NC	28227	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11892	1114 BRAWLEY SCHOOL RD.	MOORESVILLE	NC	28117	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11251	2531 CUTHBERTSON RD.	WAXHAW	NC	28173	10/14/2022	01/01/2023	04/01/2024	04/08/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02700	1993 DICKERSON BLVD	MONROE	NC	28110-2795	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11564	7686 CHARLOTTE HWY.	INDIAN LAND	SC	29707	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #10838	5220 HIGHWAY 557	CLOVER	SC	29710	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	WALGREENS #17660	12830 SOUTH TRYON ST	CHARLOTTE	NC	28273	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09084	3431 MATTHEWS-MINT HILL RD	MATTHEWS	NC	28105-4030	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11266	19631 W. CATAWBA AVE.	CORNELIUS	NC	28031	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #10614	997 E. LIBERTY ST.	YORK	SC	29745	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04870	735 CABARRUS AVE W	CONCORD	NC	28027	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	WALGREENS #17234	21500 CATAWBA AVE	CORNELIUS	NC	28031-6577	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	WALGREENS #19220	3345 PINEVILLE-MATTHEWS RD	CHARLOTTE	NC	28226	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #13985	7828 PINEVILLE MATTHEWS RD.	CHARLOTTE	NC	28226-4033	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06688	542 RIVER HWY	MOORESVILLE	NC	28117	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	WALGREENS #17027	2215 W ARROWOOD RD	CHARLOTTE	NC	28217-7939	10/14/2022	01/01/2023	02/17/2025	02/26/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS #10255	5975 WEDDINGTON MONROE RD.	MATTHEWS	NC	28104	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 10253	10 PITTS SCHOOL RD. NW	CONCORD	NC	28027	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	WALGREENS #19315	1208 SKYWAY DR	MONROE	NC	28110	10/14/2022	01/01/2023	08/02/2023	08/09/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #09184	11200 PROVIDENCE RD. WEST	CHARLOTTE	NC	28277	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12350	5455 POTTER RD.	STALLINGS	NC	28104	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	WALGREENS #17386	3716 W W T HARRIS BLVD STE J	CHARLOTTE	NC	28269-8517	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06479	1220 MATTHEWS TOWNSHIP PKWY	MATTHEWS	NC	28105-0218	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11692	500 FINCHER ST.	MONROE	NC	28112	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	WALGREENS #19702	8520 PARK RD	CHARLOTTE	NC	28210	01/09/2025	04/01/2025		04/01/2025
Contract Detail	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	04/22/2021	07/01/2021		07/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	10/13/2020	01/01/2021	10/01/2021	11/09/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	10/13/2020	01/01/2021		01/01/2021

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
Addresses	Shipping Address	Insert	Change Request		Unit Dose Solutions, Inc. 860 Aviation Pkwy #400 Morrisville, NC 27560	4/17/2025 10:31 AM
Addresses	Shipping Address	Insert	Change Request		Novant Health Pharmacy at Presbyterian Medical Center 200 Hawthorne Lane Charlotte, NC 28204	2/11/2025 6:36 AM
Details	Last Recertification Date	Update	Recertification	8/16/2023 8:26:42 AM	8/23/2024 4:35:52 PM	8/23/2024 4:35 PM
Addresses	Shipping Address	Insert	Change Request		The Presbyterian Hospital DBA Home Delivery Pharmacy 4601 Corporate Dr. NW Concord, NC 28027-9659	5/20/2024 1:25 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1366585200	5/7/2024 1:26 PM
Medicaid Billing	NPI: State	Insert	Change Request		NC	5/7/2024 1:26 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1245841279	5/7/2024 1:26 PM
Medicaid Billing	NPI: State	Insert	Change Request		NC	5/7/2024 1:26 PM
Details	Last Recertification Date	Update	Recertification	9/9/2022 1:31:30 PM	8/16/2023 8:26:42 AM	8/16/2023 8:26 AM
Addresses	Shipping Address	Insert	Change Request		Safecor Health 4060 Business Park Drive Columbus, OH 43204	8/10/2023 1:44 PM
Contacts	Primary Contact	Update	Change Request	Corazzo, Elizabeth Anne Manager Pharmacy 340B Novant Health 3362770301	Corazzo, Elizabeth Anne Pharmacy Manager 340B Novant Health, Inc 3362770301	3/2/2023 1:04 PM
Contacts	Authorizing Official	Update	Change Request	Gardner, Geoffrey SVP Finance Novant Health 3367182078	Bean, Rebecca A SVP Chief Pharmacy Executive Novant Health, Inc. 3362775862	2/9/2023 3:18 PM
Contacts	Primary Contact	Update	Profile Change Request	Hansen, Elizabeth Corazzo Supervisor Pharmacy 340B Novant Health 3362770301	Corazzo, Elizabeth Anne Manager Pharmacy 340B Novant Health 3362770301	2/7/2023 4:18 PM
Addresses	Shipping Address	Update	Change Request	Novant Health Pharmacy Services LLC 8401 University Exec Park Dr 127 Charlotte, NC 28262-3330	The Presbyterian Hospital DBA Novant Health Pharmacy 8401 University Exec Park Dr 127 Charlotte, NC 28262-3330	10/27/2022 1:12 PM
Addresses	Shipping Address	Update	Change Request	Novant Health Pharmacy Services, LLC 125 Queens Rd 180 Charlotte, NC 28204-3215	The Presbyterian Hospital DBA Novant Health Pharmacy 125 Queens Rd 180 Charlotte, NC 28204-3215	10/27/2022 1:12 PM
Details	Last Recertification Date	Update	Recertification	8/30/2021 3:04:01 PM	9/9/2022 1:31:30 PM	9/9/2022 1:31 PM
Details	Last Recertification Date	Update	Recertification	9/9/2020 5:47:17 PM	8/30/2021 3:04:01 PM	8/30/2021 3:04 PM
Addresses	Shipping Address	Insert	Change Request		Novant Health Pharmacy Services LLC 8401 University Exec Park Dr 127 Charlotte, NC 28262-3330	2/9/2021 2:54 PM
Addresses	Shipping Address	Insert	Change Request		Novant Health Pharmacy Services, LLC 125 Queens Rd 180 Charlotte, NC 28204-3215	2/9/2021 2:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 5:47 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		92642600	9/9/2020 5:47 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/9/2020 5:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 5:47 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		546255000	9/9/2020 5:47 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/9/2020 5:47 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1881647204 (SC)		9/9/2020 5:47 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1881647204 (VA)		9/9/2020 5:47 PM
Medicaid Billing	NPI: State	Update	Recertification		NC	9/9/2020 5:47 PM
Medicaid Billing	NPI: State	Update	Recertification		NC	9/9/2020 5:47 PM
Medicaid Billing	NPI: State	Update	Recertification		NC	9/9/2020 5:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1881647204	9/9/2020 5:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/9/2020 5:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1881647204	9/9/2020 5:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/9/2020 5:47 PM
Details	Last Recertification Date	Update	Recertification	9/6/2019 9:47:41 AM	9/9/2020 5:47:17 PM	9/9/2020 5:47 PM
Contacts	Authorizing Official	Update	Change Request	Terrell, Cedric A SVP Pharmacy Services Novant Health, Inc. 7043840611	Gardner, Geoffrey SVP Finance Novant Health 3367182078	1/28/2020 3:56 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1922035856 ( )		10/14/2019 5:28 PM
Details	Last Recertification Date	Update	Recertification	8/31/2018 12:12:24 PM	9/6/2019 9:47:41 AM	9/6/2019 9:47 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	3400053 (NC)		7/12/2019 12:26 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	003037041 IP (CT)		7/12/2019 12:26 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	008043573 OP (CT)		7/12/2019 12:26 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	92642600 (FL)		7/12/2019 12:26 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	5605542300001 (IL)		7/12/2019 12:26 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	4171306 (NJ)		7/12/2019 12:26 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0355244 (OH)		7/12/2019 12:26 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1007741400006 (PA)		7/12/2019 12:26 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	340053 (TN)		7/12/2019 12:26 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	81274300 (WI)		7/12/2019 12:26 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1174062970	7/12/2019 12:26 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1497708838	7/12/2019 12:26 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1396798591 ( )		11/6/2018 3:19 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1497708838 ( )		11/6/2018 3:19 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1659322972 ( )		11/6/2018 3:19 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1922035856	8/31/2018 12:12 PM
Details	Last Recertification Date	Update	Recertification	11/15/2017 10:20:32 PM	8/31/2018 12:12:24 PM	8/31/2018 12:12 PM
Contacts	Authorizing Official	Update	Change Request	Vincent, Paula President and COO, Presbyterian Medical Center Novant Health Presbyterian Medical Center 7043849656	Terrell, Cedric A SVP Pharmacy Services Novant Health, Inc. 7043840611	7/5/2018 2:52 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/3/2018 5:19 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1881647204	4/3/2018 5:19 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	4/3/2018 5:19 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/3/2018 5:19 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1881647204	4/3/2018 5:19 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		VA	4/3/2018 5:19 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003037041 IP	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		008043573 OP	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		92642600	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		5605542300001	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		4171306	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NJ	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0355244	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007741400006	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		340053	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		81274300	3/12/2018 1:53 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WI	3/12/2018 1:53 PM
Details	Last Recertification Date	Update	Recertification	8/31/2016 12:00:00 AM	11/15/2017 10:20:32 PM	11/15/2017 10:20 PM
Contacts	Primary Contact	Update	Recertification	Hansen, Elizabeth Supervisor Pharmacy 340B Novant Health 3362770301	Hansen, Elizabeth Corazzo Supervisor Pharmacy 340B Novant Health 3362770301	11/6/2017 10:31 AM
Contacts	Authorizing Official	Update		Vincent, Paula President and COO, Presbyterian Medical Center 7043849656	Vincent, Paula President and COO, Presbyterian Medical Center Novant Health Presbyterian Medical Center 7043849656	10/16/2017 11:01 AM
Contacts	Primary Contact	Update		Hansen, Elizabeth Supervisor Pharmacy 340B 3362770301	Hansen, Elizabeth Supervisor Pharmacy 340B Novant Health 3362770301	9/27/2017 2:34 PM
Contacts	Primary Contact	Update		Hissam, Jennifer Director of Pharmacy 7043845263	Hansen, Elizabeth Supervisor Pharmacy 340B 3362770301	8/3/2017 3:00 PM
Contacts	Authorizing Official	Insert			Vincent, Paula President and COO, Presbyterian Medical Center 7043849656	7/28/2017 6:12 PM
Addresses	Main Address	Insert			200 HAWTHORNE LANE CHARLOTTE, NC 28204	7/28/2017 6:12 PM
Contacts	Primary Contact	Update		HILDRETH, JONNIE DIRECTOR OF PHARMACY 7043845263	Hissam, Jennifer Director of Pharmacy 7043845263	2/7/2017 10:22 AM
Details	Last Recertification Date	Update		8/19/2015 12:00:00 AM	8/31/2016 12:00:00 AM	8/31/2016 3:55 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/19/2015 10:01 AM
Details	Last Recertification Date	Update		8/14/2014 12:00:00 AM	8/19/2015 12:00:00 AM	8/19/2015 10:01 AM
Medicaid Billing	NPI: Number	Insert			1396798591	7/30/2015 3:12 PM
Medicaid Billing	NPI: Number	Insert			1497708838	7/30/2015 3:12 PM
Medicaid Billing	NPI: Number	Insert			1659322972	7/30/2015 3:12 PM
Details	Last Recertification Date	Update		9/10/2013 12:00:00 AM	8/14/2014 12:00:00 AM	8/14/2014 2:49 PM
Medicaid Billing	NPI: Number	Insert			1881647204	9/10/2013 9:24 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/10/2013 12:00:00 AM	9/10/2013 9:24 AM
Medicaid Billing	Medicaid: Number	Update		340053	3400053	7/10/2013 8:15 AM
Details	Entity Name	Update		Presbyterian Hospital dba Norvant Health Presbyterian Medical Center	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	7/3/2013 9:07 AM
Details	Entity Name	Update		PRESBYTERIAN HOSPITAL	Presbyterian Hospital dba Norvant Health Presbyterian Medical Center	7/3/2013 8:50 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/21/2012 7:52 AM
Contacts	Primary Contact	Insert			HILDRETH, JONNIE DIRECTOR OF PHARMACY 7043845263	10/28/2010 4:39 PM
Details	Last Recertification Date	Insert				10/28/2010 4:39 PM
Details	Grant Number	Insert				10/28/2010 4:39 PM
Details	340B ID	Insert			DSH340053	10/28/2010 4:39 PM
Details	Is Authorizing Official EHB Data	Insert				10/28/2010 4:39 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/28/2010 4:39 PM
Details	Medicare Provider Number	Insert			340053	10/28/2010 4:39 PM
Details	Entity Name	Insert			PRESBYTERIAN HOSPITAL	10/28/2010 4:39 PM
Details	Program Code	Insert			DSH	10/28/2010 4:39 PM
Details	Entity Subname	Insert				10/28/2010 4:39 PM
Dates	Participating Approval Date	Insert			2/27/2008 12:00:00 AM	10/28/2010 4:39 PM
Details	State	Insert			Active	10/28/2010 4:39 PM
Dates	Registration Date	Insert			2/26/2008 12:00:00 AM	10/28/2010 4:39 PM
Dates	Signed By Date	Insert				10/28/2010 4:39 PM
Dates	Start Date	Insert			4/1/2008 12:00:00 AM	10/28/2010 4:39 PM
Terminations	Termination Comments	Insert				10/28/2010 4:39 PM
Terminations	Termination Date	Insert				10/28/2010 4:39 PM
Terminations	Termination Effective Date	Insert				10/28/2010 4:39 PM
Terminations	Termination Reason	Insert				10/28/2010 4:39 PM
Details	Comments Public	Insert			10/28/10 NPI # REVISED (WAS 340003)	10/28/2010 4:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	2/26/2008 9:56 AM
Medicaid Billing	Medicaid: Number	Insert			340053	2/26/2008 9:56 AM
Medicaid Billing	Medicaid: State	Insert			NC	2/26/2008 9:56 AM