340B Drug Pricing Program Database


DSH340113 CAROLINAS MEDICAL CENTER (Active) - information as of 6/9/2025 11:04:21 PM

Main Details
CAROLINAS MEDICAL CENTER
Disproportionate Share Hospital
No
DSH340113
340113


Additional Details
Active
3/1/2008
8/1/1993
3/1/2008
9/4/2024

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

1000 BLYTHE BLVD
CHARLOTTE, NC 28203

Atrium Health Accounts Payable
PO Box 516
Elmsford, NY 10523


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
3/22/12 Added NPI #; 03/01/2012 ADDRESS 1350 SOUTH KINGS DRIVE MOVED TO CHILD ID (DSH340113D)03/22/2012
03/01/2012 ADDRESS 1350 SOUTH KINGS DRIVE MOVED TO CHILD ID (DSH340113D)03/01/2012
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
SC1507276,3366881295789907,1053358945
NC 1295789907,1366558959,1427164052,1497861017,1053358945,1659475754,1588259220
Shipping Addresses

CMC Pharmacy
1000 Blythe Blvd
Charlotte, NC 28203

Healthy @ Home Pharmacy - CMC Home Infusion and Equipment
1701 Abbey Place
Charlotte, NC 28209-3731

Atrium Health Pharmacy Myers Park
1350 S. Kings Drive
Suite 101
Charlotte, NC 28207

Atrium Health Pharmacy Biddle Point
1801 Rozzelles Ferry Road
Charlotte, NC 28208

Atrium Health Pharmacy NorthPark
251 Eastway Drive
Charlotte, NC 28213

Carolinas Medical Center
1000 Blythe Blvd
Room 04M218
Charlotte, NC 28203

Atrium Health Pharmacy Billingsley
501 Billingsley Road
Charlotte, NC 28211

Atrium Health Pharmacy at CMC ED
1000 Blythe Blvd
Carolinas Medical Center
Suite 03-K-112
Charlotte, NC 28203

Levine Cancer Institute Pharmacy
447 McAlister Road
Suite 1600
Lincolnton, NC 28092

UDS
860 Aviation Parkway
Suite 400A
Morrisville, NC 27560

Levine Cancer Institute Pharmacy
1550 Faulk Street
Suite 1500
Monroe, NC 28112

Levine Cancer Institute
1100 Healing Way
Suite 31
Matthews, NC 28104

Levine Cancer Institute Pharmacy
100 Medical Park Drive
Suite 010C
Concord, NC 28025

Levine Cancer Institute Pharmacy
1021 Morehead Medical Drive
Suites 4202 and 40301
Charlotte, NC 28204

Pediatric Outpatient Infusion Center (CLIV) Pharmacy
1001 Blythe Blvd
Suite 3500
Charlotte, NC 28203

Atrium Health Kenilworth Pharmacy Infusion
1225 Harding Place
Suite 1400
Charlotte, NC 28204

Levine Cancer Institute Pharmacy
201 East Grover St
Rooms 1133 and 1134
Shelby, NC 28150
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750204/13/202007/01/2020  07/01/2020
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/13/202007/01/2020  07/01/2020
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884904/13/202007/01/2020  07/01/2020
Contract DetailACCREDO HEALTH GROUP INC422 GALLIMORE DAIRY RD SUITE A
GREENSBORONC2740901/15/202104/01/2021  04/01/2021
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349204/13/202007/01/2020  07/01/2020
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624104/13/202007/01/2020 03/19/202403/19/2024
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282204/13/202007/01/2020  07/01/2020
Contract DetailACCREDO HEALTH GROUP, INC.11411 STRANG LINE RD STE A
LENEXAKS6621501/15/202104/01/2021  04/01/2021
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607501/19/202204/01/2022  04/01/2022
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280910/12/201701/01/2018 03/28/202404/01/2024
Contract DetailATRIUM HEALTH AT HOME INFUSION AND EQUIP1701 ABBEY PL
CHARLOTTENC28209-373304/18/201204/18/2012 03/01/202403/04/2024
Contract DetailATRIUM HEALTH PHARMACY PAVILION920 CHURCH ST N
CONCORDNC2802507/06/201607/01/2016  02/23/2021
Contract DetailATRIUM HEALTH PHARMACY SOUTHPARK4525 CAMERON VALLEY PKWY STE 1200
CHARLOTTENC2821101/15/202004/01/2020  02/23/2021
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/12/201701/01/2018  10/12/2017
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005610/12/201701/01/2018  10/12/2017
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/12/201701/01/2018  10/12/2017
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/19/202001/01/2021  01/01/2021
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/19/202001/01/2021  01/01/2021
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/12/201701/01/2018  10/12/2017
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761710/12/201701/01/2018  10/12/2017
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813310/19/202001/01/2021  01/01/2021
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237410/12/201701/01/2018  10/12/2017
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911910/19/202001/01/2021  01/01/2021
Contract DetailCAROLINACARE4400 GOLF ACRES DR BLDG J STE C
CHARLOTTENC28208-596807/14/201510/01/2015  07/25/2017
Contract DetailCAROLINACARE PHARMACYP O BOX 31691 4400 GOLF ACRES DRIVE
BUILDING J, SUITE C 		CHARLOTTENC2820804/16/201407/01/2014 10/15/201507/25/2017
Contract DetailCHS PHARMACY SERVICES, INC.ATRIUM HEALTH PHARMACY KENILWORTH 1225 HARDING PL
SUITE 1400 		CHARLOTTENC28204-282604/13/201704/13/2017  02/23/2021
Contract DetailCHS Pharmacy Services, Inc.Atrium Health Pharmacy Medical Center Plaza 1001 Blythe Blvd
201 		CharlotteNC28203-586604/13/202107/01/2021  07/01/2021
Contract DetailCMC RX MORROCROFT4525 CAMERON VALLEY PARKWAY SUITE 1200
CHARLOTTENC2821110/28/201301/01/2014 10/15/201507/25/2017
Contract DetailCMC RX GATEWAY1085 NORTHEAST GATEWAY CT, NE
CONCORDNC2802507/17/201410/01/2014 10/15/201507/25/2017
Contract DetailCMC RX MATTHEWS332 NORTH TRADE STREET SUITE 1300
MATTHEWSNC2810510/28/201301/01/2014 10/15/201507/25/2017
Contract DetailCMC RX MEDICAL CENTER PLAZA1001 BLYTHE BLVD SUITE 201
CHARLOTTENC2820307/17/201410/01/2014 01/30/202301/31/2023
Contract DetailCMC RX NORTH CROSS16455 STATESVILLE ROAD SUITE 101
HUNTERSVILLENC28078-713507/17/201410/01/2014 10/15/201507/25/2017
Contract DetailCMC RX PAVILION  920 CHURCH STREET, NORTH
CONCORDNC2802507/17/201410/01/2014 06/29/201607/25/2017
Contract DetailCMC RX STEELE CREEK13640 STEELECROFT PARKWAY SUITE 120
CHARLOTTENC2827807/17/201410/01/2014 10/15/201507/25/2017
Contract DetailCMC-ENTERPRISE PHARMACY4400 GOLF ACRES DRIVE BUILDING J, SUITE E
CHARLOTTENC28208-599001/16/201404/01/2014 10/15/201507/25/2017
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 9401-J SOUTHERN PINE BLVD
CHARLOTTENC2827301/15/202104/01/2021 09/30/202204/07/2025
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502810/19/202001/01/2021  01/01/2021
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503301/18/202304/01/2023  04/01/2023
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268301/18/202104/01/2021 01/30/202301/31/2023
Contract DetailESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111204/13/202007/01/2020  07/01/2020
Contract DetailEXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313404/13/202007/01/2020  07/01/2020
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801604/13/202007/01/2020  07/01/2020
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607504/13/202007/01/2020  07/01/2020
Contract DetailLYNNFIELD DRUG INCDBA FREEDOM FERTILITY PHARMACY 374 MERRIMAC ST STE 100
NEWBURYPORTMA0195004/13/202007/01/2020  07/01/2020
Contract DetailNORTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07056 2115 BEATTIES FORD RD
CHARLOTTENC2821601/15/202104/01/2021  04/01/2021
Contract DetailNORTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02560 2035 NORTH SHARON AMITY RD
CHARLOTTENC2820501/15/202104/01/2021  04/01/2021
Contract DetailNORTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03694 2325 VILLAGE LAKE DR.
CHARLOTTENC2821201/15/202104/01/2021  04/01/2021
Contract DetailNORTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03185 1533 SOUTH BLVD
CHARLOTTENC2820301/15/202104/01/2021  04/01/2021
Contract DetailNORTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07089 231 N. GRAHAM STREET
CHARLOTTENC2820201/15/202104/01/2021  04/01/2021
Contract DetailNORTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05583 2939 THE PLAZA
CHARLOTTENC2820501/15/202104/01/2021  04/01/2021
Contract DetailNORTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07536 4307 WILGROVE-MINT HILL RD.
MINT HILLNC2822701/15/202104/01/2021  04/01/2021
Contract DetailNORTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03806 1403 E. MAIN ST.
LINCOLNTONNC2809201/15/202104/01/2021  04/01/2021
Contract DetailNORTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02559 10515 MALLARD CREEK ROAD
CHARLOTTENC2826201/15/202104/01/2021  04/01/2021
Contract DetailNORTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04202 1830 WEST DIXON BOULEVARD
SHELBYNC2815201/15/202104/01/2021  04/01/2021
Contract DetailNORTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07688 3440 WILKINSON BOULEVARD
CHARLOTTENC2820801/15/202104/01/2021  04/01/2021
Contract DetailOPTUM INFUSION SERVICES 305, LLC15529 COLLEGE BLVD.
LENEXAKS66219-135104/15/202507/01/2025  04/15/2025
Contract DetailOPTUM INFUSION SERVICES 553, LLC6531 MERIDIEN DR SUITE 113
RALEIGHNC2761604/14/202507/01/2025  04/14/2025
Contract DetailOPTUM PHARMACY 700, LLC5700 DOT COM CT, STE 1000
OVIEDOFL3276501/18/202104/01/2021  04/01/2021
Contract DetailOPTUM PHARMACY 701, LLC4015 SHOPTON RD STE 600
CHARLOTTENC28217-302501/18/202104/01/2021  04/01/2021
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850706/14/202206/16/2022  06/16/2022
Contract DetailOPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520404/14/202507/01/2025  04/14/2025
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713001/18/202104/01/2021  04/01/2021
Contract DetailOPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824901/18/202104/01/2021  04/01/2021
Contract DetailOPTUM PHARMACY 705, LLC3539 BLUECUTT RD
COLUMBUSMS3970501/18/202104/01/2021  04/01/2021
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729801/18/202104/01/2021  04/01/2021
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508501/18/202104/01/2021  04/01/2021
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514610/12/201701/01/2018  10/12/2017
Contract DetailPROCARE PHARMACY, L.L.C.CVS/PHARMACY #48637 2700 NORTHEAST EXPY NE STE B800
BUILDING B 		ATLANTAGA3034504/13/202007/01/2020  07/01/2020
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523310/19/202001/01/2021  01/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920310/19/202001/01/2021  01/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681310/19/202001/01/2021  01/01/2021
Contract DetailPROCARE PHARMACY, LLCDBA CVS/PHARMACY#2980 601 S. KINGS DR.
CHARLOTTENC2820404/15/202007/01/2020  07/01/2020
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16405 1500 E 3RD ST STE A
CHARLOTTENC2820401/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #17660 12830 SOUTH TRYON ST
CHARLOTTENC2827301/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 04870 735 CABARRUS AVE W
CONCORDNC2802701/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #10838 5220 HIGHWAY 557
CLOVERSC2971001/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #17014 3534 MT HOLLY-HUNTERSVILLE RD
CHARLOTTENC2821601/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #10608 1000 DALLAS CHERRYVILLE HWY.
DALLASNC2803401/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #17234 21500 CATAWBA AVE
CORNELIUSNC28031-657701/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #15008 101 S TRYON ST STE 22
CHARLOTTENC2828001/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #19877 10020 PINEVILLE MATTHEWS RD
PINEVILLENC2813401/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 07766 1510 SARDIS RD N
CHARLOTTENC28270-140801/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #11564 7686 CHARLOTTE HWY.
INDIAN LANDSC2970701/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 07401 13720 HIGHWAY 74
INDIAN TRAILNC28079-760001/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #10154 6028 S. NC 16 HWY.
MAIDENNC2865001/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #11892 1114 BRAWLEY SCHOOL RD.
MOORESVILLENC2811701/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #17368 617 HIGHLAND ST
MOUNT HOLLYNC2812001/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 09661 705 JAKE ALEXANDER BLVD WEST
SALISBURYNC2814701/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 06479 1220 MATTHEWS TOWNSHIP PKWY
MATTHEWSNC28105-021801/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 02700 1993 DICKERSON BLVD
MONROENC28110-279501/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #17020 1295 E MAIN ST
ROCK HILLSC2973001/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #13985 7828 PINEVILLE MATTHEWS RD.
CHARLOTTENC28226-403301/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 06688 542 RIVER HWY
MOORESVILLENC2811701/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 04871 1310 S CANNON BLVD
KANNAPOLISNC2808301/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #19342 110 W GARRISON BLVD
GASTONIANC2805201/18/202304/01/2023 03/27/202404/01/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 10253 10 PITTS SCHOOL RD. NW
CONCORDNC2802701/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #15253 525 N. CANNON BLVD.
KANNAPOLISNC28083-380101/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #11692 500 FINCHER ST.
MONROENC2811201/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #16120 533 N MAIN ST
TROUTMANNC2816601/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #10619 840 NC 24 27 BYPASS E
ALBEMARLENC2800101/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #17027 2215 W ARROWOOD RD
CHARLOTTENC28217-793901/18/202304/01/2023 02/17/202502/17/2025
Contract DetailWALGREEN CO.DBA: WALGREENS # 04843 6802 W WILKINSON BLVD
BELMONTNC2801201/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #10287 9848 GILEAD RD.
HUNTERSVILLENC2807801/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #18350 2907 HIGHWAY160 W
FORT MILLSC2970801/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 07278 1906 W INNES STREET
SALISBURYNC2814401/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 10448 1101 HIGHWAY 9 BYP W
LANCASTERSC29720-171001/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 05877 1902 WEST FRANKLIN BLVD.
GASTONIANC2805201/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #17880 508 HWY 29N
CHINA GROVENC2802301/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 07400 16711 BIRKDALE COMMONS PKWY
HUNTERSVILLENC28078-441201/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 07767 5230 POPLAR TENT ROAD
CONCORDNC28027-775701/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #11765 1230 E. MAIN ST.
LINCOLNTONNC2809201/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #17386 3716 W W T HARRIS BLVD STE J
CHARLOTTENC28269-851701/18/202304/01/2023 04/29/202504/29/2025
Contract DetailWALGREEN CO.DBA WALGREENS #16087 9428 STEELE CREEK RD.
CHARLOTTENC2827301/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #11251 2531 CUTHBERTSON RD.
WAXHAWNC2817301/18/202304/01/2023 04/01/202405/13/2024
Contract DetailWALGREEN CO.WALGREENS #17073 4133 PARK RD
CHARLOTTENC2820901/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #19702 8520 PARK RD
CHARLOTTENC2821001/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 07699 1495 CONCORD PKWY N
CONCORDNC28025-081801/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 06480 2800 W MALLARD CREEK CHURCH RD
CHARLOTTENC2826201/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 02696 951 DAVIE AVE
STATESVILLENC28677-530101/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #15274 1645 CRANIUM DRIVE
ROCK HILLSC2973201/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #10255 5975 WEDDINGTON MONROE RD.
MATTHEWSNC2810401/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #11210 2000 CELANESE RD.
ROCK HILLSC2973201/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #13036 7385 NC 73 HIGHWAY
DENVERNC2803701/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #19315 1208 SKYWAY DR
MONROENC2811001/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 04548 6848 ALBEMARLE RD.
CHARLOTTENC2821201/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #19992 205 SALISBURY AVE
ALBEMARLENC2800101/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #19943 2465 S NEW HOPE RD
GASTONIANC2805401/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #12350 5455 POTTER RD.
STALLINGSNC2810401/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 10162 1716 PLEASANT RD
FORT MILLSC29708-781501/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 04842 1008 OAKLAND AVE
ROCK HILLSC2973201/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 07859 2975 UNION ROAD
GASTONIANC28054-602301/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #11968 1250 TOM HALL ST.
FORT MILLSC2971501/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS SPECIALTY PHARMACY #16313 2816 ERWIN ROAD SUITE 105
DURHAMNC2770501/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 10133 1505 EAST INNES STREET
SALISBURYNC2814601/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #18121 2400 LITTLE ROCK RD
CHARLOTTENC2821401/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.COMMUNITY, A WALGREENS PHARMACY #16420 103 COMMERCE CENTRE DR.
SUITE 101 		HUNTERSVILLENC2807801/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #11266 19631 W. CATAWBA AVE.
CORNELIUSNC2803101/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #19646 7115 E W. T. HARRIS BLVD
CHARLOTTENC2822701/18/202304/01/2023 04/22/202504/22/2025
Contract DetailWALGREEN CO.DBA WALGREENS #15392 4625 HYLAS LANE
HUNTERSVILLENC2807801/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 06742 2500 E FRANKLIN BLVD
GASTONIANC28056-726201/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 09084 3431 MATTHEWS-MINT HILL RD
MATTHEWSNC28105-403001/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #19220 3345 PINEVILLE-MATTHEWS RD
CHARLOTTENC2822601/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #10614 997 E. LIBERTY ST.
YORKSC2974501/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #18115 1716 E BROAD ST
STATESVILLENC2862501/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #17641 230 E PLAZA DR
MOORESVILLENC2811501/18/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #19066 4305 NC HIGHWAY 49 S
HARRISBURGNC28075-752801/18/202304/01/2023  04/01/2023
Contract DetailWALGREENS MAIL SERVICE, LLCWALGREENS MAIL SERVICE #03397 8350 S RIVER PARKWAY
TEMPEAZ8528401/18/202304/01/2023  04/01/2023
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527501/18/202304/01/2023  04/01/2023
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818801/18/202304/01/2023  04/01/2023
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503301/18/202304/01/2023  04/01/2023
Contract DetailWALGREENS.COM, INC.DBA: WALGREENS 2225 S. PRICE ROAD
CHANDLERAZ8528601/18/202304/01/2023  04/01/2023
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
AddressesShipping AddressDeleteRecertificationLevine Cancer Institute Pharmacy 201 East Grover St Suite 1133 Shelby, NC 28150 9/4/2024 10:13 AM
AddressesShipping AddressInsertRecertification Levine Cancer Institute Pharmacy 201 East Grover St Rooms 1133 and 1134 Shelby, NC 281509/4/2024 10:13 AM
DetailsLast Recertification DateUpdateRecertification9/6/2023 9:28:02 AM9/4/2024 10:13:09 AM9/4/2024 10:13 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
AddressesShipping AddressInsertChange Request Atrium Health Kenilworth Pharmacy Infusion 1225 Harding Place Suite 1400 Charlotte, NC 282047/16/2024 6:43 AM
Medicaid BillingNPI: NumberInsertChange Request 12957899077/16/2024 6:43 AM
Medicaid BillingNPI: StateInsertChange Request SC7/16/2024 6:43 AM
Medicaid BillingNPI: NumberInsertChange Request 10533589457/16/2024 6:43 AM
Medicaid BillingNPI: StateInsertChange Request SC7/16/2024 6:43 AM
AddressesShipping AddressInsertChange Request Pediatric Outpatient Infusion Center (CLIV) Pharmacy 1001 Blythe Blvd Suite 3500 Charlotte, NC 2820310/26/2023 9:12 AM
Medicaid BillingMedicaid: NumberDeleteRecertification93756534 (NM) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertificationCAR0113N (AL) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification003223331A (GA) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification01520493 (KY) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification110027109B (MA) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1295789907-001 (ME) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification00097237 (MS) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification3096344 (NH) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007534530004 (PA) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification2036578 (WA) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification3043387 (CT) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification32050200 (DC) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification0548222 (IA) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification016956401 (MO) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification072536801 (TX) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification9000185407 (CO) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification022529400 (FL) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification30003945240002 (KS) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification300042056 (IN) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberInsertRecertification 15072769/6/2023 9:28 AM
Medicaid BillingMedicaid: StateInsertRecertification SC9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertificationQ050668 (TN) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification000104101A (GA) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification125311105 (AR) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification320546 (AZ) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification003043387 (CT) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification032050200 (DC) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification548222 (IA) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification561398929001 (IL) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1748412 (LA) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification217955500 (MD) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification16956401 (MO) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification97237 (MS) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification00350665 (NY) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification2625476 (OH) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification10069210A (OK) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification203849 (OR) 9/6/2023 9:28 AM
Medicaid BillingMedicaid: NumberDeleteRecertification72536801 (TX) 9/6/2023 9:28 AM
Medicaid BillingNPI: NumberDeleteRecertification1295789907 (IA) 9/6/2023 9:28 AM
Medicaid BillingNPI: NumberDeleteRecertification1295789907 (ID) 9/6/2023 9:28 AM
Medicaid BillingNPI: NumberDeleteRecertification1295789907 (MN) 9/6/2023 9:28 AM
Medicaid BillingNPI: NumberDeleteRecertification1295789907 (VA) 9/6/2023 9:28 AM
Medicaid BillingNPI: NumberDeleteRecertification1295789907 (WI) 9/6/2023 9:28 AM
Medicaid BillingNPI: NumberDeleteRecertification1295789907 (CA) 9/6/2023 9:28 AM
Medicaid BillingNPI: NumberDeleteRecertification1295789907 (MI) 9/6/2023 9:28 AM
Medicaid BillingNPI: NumberInsertRecertification 15882592209/6/2023 9:28 AM
Medicaid BillingNPI: StateInsertRecertification NC9/6/2023 9:28 AM
DetailsLast Recertification DateUpdateRecertification12/5/2022 6:21:20 AM9/6/2023 9:28:02 AM9/6/2023 9:28 AM
AddressesShipping AddressInsertChange Request Levine Cancer Institute Pharmacy 100 Medical Park Drive Suite 010C Concord, NC 280251/17/2023 12:24 PM
AddressesShipping AddressInsertChange Request Levine Cancer Institute Pharmacy 1021 Morehead Medical Drive Suites 4202 and 40301 Charlotte, NC 282041/17/2023 12:24 PM
AddressesBilling AddressUpdateChange RequestAtrium Health Accounts Payable PO Box 5379 Portland, OR 97228-5379Atrium Health Accounts Payable PO Box 516 Elmsford, NY 105231/17/2023 12:24 PM
Medicaid BillingNPI: NumberInsertRecertification 105335894512/5/2022 6:21 AM
Medicaid BillingNPI: StateInsertRecertification NC12/5/2022 6:21 AM
Medicaid BillingNPI: NumberInsertRecertification 165947575412/5/2022 6:21 AM
Medicaid BillingNPI: StateInsertRecertification NC12/5/2022 6:21 AM
DetailsLast Recertification DateUpdateRecertification9/10/2021 9:43:12 AM12/5/2022 6:21:20 AM12/5/2022 6:21 AM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request092547100 (FL) 8/24/2022 10:39 AM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request9501101 (CO) 8/24/2022 10:39 AM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False8/24/2022 10:39 AM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 90001854078/24/2022 10:39 AM
Medicaid BillingMedicaid: StateInsertGroup Change Request CO8/24/2022 10:39 AM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False8/24/2022 10:39 AM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 0225294008/24/2022 10:39 AM
Medicaid BillingMedicaid: StateInsertGroup Change Request FL8/24/2022 10:39 AM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False8/24/2022 10:39 AM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 300039452400028/24/2022 10:39 AM
Medicaid BillingMedicaid: StateInsertGroup Change Request KS8/24/2022 10:39 AM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False8/24/2022 10:39 AM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 3000420568/24/2022 10:39 AM
Medicaid BillingMedicaid: StateInsertGroup Change Request IN8/24/2022 10:39 AM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request92547100 (FL) 8/24/2022 10:39 AM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request95011011 (CO) 8/24/2022 10:39 AM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request100106450A (KS) 8/24/2022 10:39 AM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request4105335 (MT) 8/24/2022 10:39 AM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request56139892900 (NE) 8/24/2022 10:39 AM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request20001280 (NH) 8/24/2022 10:39 AM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request1007534530001 (PA) 8/24/2022 10:39 AM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request3003316 (WA) 8/24/2022 10:39 AM
AddressesShipping AddressUpdateChange RequestLevine Cancer Institute Pharmacy 447 McAlister Road Suite 1502 Lincolnton, NC 28092Levine Cancer Institute Pharmacy 447 McAlister Road Suite 1600 Lincolnton, NC 280926/30/2022 12:49 PM
AddressesShipping AddressUpdateChange RequestLevine Cancer Institute Pharmacy 1100 Healing Way Suite 31 Matthews, NC 28104Levine Cancer Institute 1100 Healing Way Suite 31 Matthews, NC 281041/21/2022 1:51 PM
AddressesShipping AddressInsertChange Request Levine Cancer Institute Pharmacy 1100 Healing Way Suite 31 Matthews, NC 281041/13/2022 9:52 AM
AddressesShipping AddressInsertChange Request Levine Cancer Institute Pharmacy 1550 Faulk Street Suite 1500 Monroe, NC 2811212/21/2021 7:43 AM
AddressesShipping AddressInsertRecertification UDS 860 Aviation Parkway Suite 400A Morrisville, NC 275609/10/2021 9:43 AM
Medicaid BillingMedicaid: NumberDeleteRecertification0340113 (VT) 9/10/2021 9:43 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2021 9:43 AM
Medicaid BillingMedicaid: NumberInsertRecertification 95011019/10/2021 9:43 AM
Medicaid BillingMedicaid: StateInsertRecertification CO9/10/2021 9:43 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2021 9:43 AM
Medicaid BillingMedicaid: NumberInsertRecertification 30433879/10/2021 9:43 AM
Medicaid BillingMedicaid: StateInsertRecertification CT9/10/2021 9:43 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2021 9:43 AM
Medicaid BillingMedicaid: NumberInsertRecertification 320502009/10/2021 9:43 AM
Medicaid BillingMedicaid: StateInsertRecertification DC9/10/2021 9:43 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2021 9:43 AM
Medicaid BillingMedicaid: NumberInsertRecertification 05482229/10/2021 9:43 AM
Medicaid BillingMedicaid: StateInsertRecertification IA9/10/2021 9:43 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2021 9:43 AM
Medicaid BillingMedicaid: NumberInsertRecertification 0169564019/10/2021 9:43 AM
Medicaid BillingMedicaid: StateInsertRecertification MO9/10/2021 9:43 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2021 9:43 AM
Medicaid BillingMedicaid: NumberInsertRecertification 0725368019/10/2021 9:43 AM
Medicaid BillingMedicaid: StateInsertRecertification TX9/10/2021 9:43 AM
Medicaid BillingMedicaid: NumberDeleteRecertification807415100 (ID) 9/10/2021 9:43 AM
Medicaid BillingMedicaid: NumberDeleteRecertification179230001 (ME) 9/10/2021 9:43 AM
Medicaid BillingMedicaid: NumberDeleteRecertification340113 (VT) 9/10/2021 9:43 AM
Medicaid BillingMedicaid: NumberDeleteRecertification80627000 (WI) 9/10/2021 9:43 AM
Medicaid BillingNPI: NumberInsertRecertification 12957899079/10/2021 9:43 AM
Medicaid BillingNPI: StateInsertRecertification CA9/10/2021 9:43 AM
Medicaid BillingNPI: NumberInsertRecertification 12957899079/10/2021 9:43 AM
Medicaid BillingNPI: StateInsertRecertification MI9/10/2021 9:43 AM
Medicaid BillingNPI: NumberInsertRecertification 13665589599/10/2021 9:43 AM
Medicaid BillingNPI: StateInsertRecertification NC9/10/2021 9:43 AM
Medicaid BillingNPI: NumberInsertRecertification 14271640529/10/2021 9:43 AM
Medicaid BillingNPI: StateInsertRecertification NC9/10/2021 9:43 AM
Medicaid BillingNPI: NumberInsertRecertification 14978610179/10/2021 9:43 AM
Medicaid BillingNPI: StateInsertRecertification NC9/10/2021 9:43 AM
DetailsLast Recertification DateUpdateRecertification9/10/2020 5:15:55 PM9/10/2021 9:43:12 AM9/10/2021 9:43 AM
AddressesShipping AddressInsertChange Request Levine Cancer Institute Pharmacy 201 East Grover St Suite 1133 Shelby, NC 281506/28/2021 3:57 PM
AddressesShipping AddressInsertChange Request Levine Cancer Institute Pharmacy 447 McAlister Road Suite 1502 Lincolnton, NC 280926/28/2021 3:57 PM
AddressesShipping AddressDeleteChange RequestAtrium Health Pharmacy Behavioral 501 Billingsley Road Charlotte, NC 28211 3/24/2021 9:12 AM
AddressesShipping AddressInsertChange Request Atrium Health Pharmacy Billingsley 501 Billingsley Road Charlotte, NC 282113/24/2021 9:12 AM
AddressesShipping AddressInsertChange Request Atrium Health Pharmacy at CMC ED 1000 Blythe Blvd Carolinas Medical Center Suite 03-K-112 Charlotte, NC 282033/24/2021 9:12 AM
AddressesShipping AddressInsertChange Request Carolinas Medical Center 1000 Blythe Blvd Room 04M218 Charlotte, NC 2820310/14/2020 9:22 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2020 5:15 PM
Medicaid BillingMedicaid: NumberInsertRecertification CAR0113N9/10/2020 5:15 PM
Medicaid BillingMedicaid: StateInsertRecertification AL9/10/2020 5:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2020 5:15 PM
Medicaid BillingMedicaid: NumberInsertRecertification 0925471009/10/2020 5:15 PM
Medicaid BillingMedicaid: StateInsertRecertification FL9/10/2020 5:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2020 5:15 PM
Medicaid BillingMedicaid: NumberInsertRecertification 003223331A9/10/2020 5:15 PM
Medicaid BillingMedicaid: StateInsertRecertification GA9/10/2020 5:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2020 5:15 PM
Medicaid BillingMedicaid: NumberInsertRecertification 015204939/10/2020 5:15 PM
Medicaid BillingMedicaid: StateInsertRecertification KY9/10/2020 5:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2020 5:15 PM
Medicaid BillingMedicaid: NumberInsertRecertification 110027109B9/10/2020 5:15 PM
Medicaid BillingMedicaid: StateInsertRecertification MA9/10/2020 5:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2020 5:15 PM
Medicaid BillingMedicaid: NumberInsertRecertification 1295789907-0019/10/2020 5:15 PM
Medicaid BillingMedicaid: StateInsertRecertification ME9/10/2020 5:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2020 5:15 PM
Medicaid BillingMedicaid: NumberInsertRecertification 000972379/10/2020 5:15 PM
Medicaid BillingMedicaid: StateInsertRecertification MS9/10/2020 5:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2020 5:15 PM
Medicaid BillingMedicaid: NumberInsertRecertification 30963449/10/2020 5:15 PM
Medicaid BillingMedicaid: StateInsertRecertification NH9/10/2020 5:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2020 5:15 PM
Medicaid BillingMedicaid: NumberInsertRecertification 10075345300049/10/2020 5:15 PM
Medicaid BillingMedicaid: StateInsertRecertification PA9/10/2020 5:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2020 5:15 PM
Medicaid BillingMedicaid: NumberInsertRecertification 03401139/10/2020 5:15 PM
Medicaid BillingMedicaid: StateInsertRecertification VT9/10/2020 5:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2020 5:15 PM
Medicaid BillingMedicaid: NumberInsertRecertification 20365789/10/2020 5:15 PM
Medicaid BillingMedicaid: StateInsertRecertification WA9/10/2020 5:15 PM
Medicaid BillingMedicaid: NumberDeleteRecertification3400113 (NC) 9/10/2020 5:15 PM
Medicaid BillingNPI: NumberDeleteRecertification1295789907 ( ) 9/10/2020 5:15 PM
Medicaid BillingNPI: NumberInsertRecertification 12957899079/10/2020 5:15 PM
Medicaid BillingNPI: StateInsertRecertification IA9/10/2020 5:15 PM
Medicaid BillingNPI: NumberInsertRecertification 12957899079/10/2020 5:15 PM
Medicaid BillingNPI: StateInsertRecertification ID9/10/2020 5:15 PM
Medicaid BillingNPI: NumberInsertRecertification 12957899079/10/2020 5:15 PM
Medicaid BillingNPI: StateInsertRecertification MN9/10/2020 5:15 PM
Medicaid BillingNPI: NumberInsertRecertification 12957899079/10/2020 5:15 PM
Medicaid BillingNPI: StateInsertRecertification NC9/10/2020 5:15 PM
Medicaid BillingNPI: NumberInsertRecertification 12957899079/10/2020 5:15 PM
Medicaid BillingNPI: StateInsertRecertification VA9/10/2020 5:15 PM
Medicaid BillingNPI: NumberInsertRecertification 12957899079/10/2020 5:15 PM
Medicaid BillingNPI: StateInsertRecertification WI9/10/2020 5:15 PM
DetailsLast Recertification DateUpdateRecertification9/11/2019 1:39:30 PM9/10/2020 5:15:55 PM9/10/2020 5:15 PM
ContactsAuthorizing OfficialUpdateAO Change RequestHaynes, Ken President and Executive Vice President Atrium Health 7043556305Mabe, Don McCoy Chief Pharmacy Officer Atrium Health 70451276238/14/2020 11:17 AM
ContactsPrimary ContactUpdateChange RequestPaul-Aviles, Fern Assistant Vice President, Pharmacy Atrium Health 7046499691Paul-Aviles, Fern AVP, Pharmacy Atrium Health 70464996916/4/2020 8:04 AM
ContactsAuthorizing OfficialUpdateAO Change RequestLeighty, Scott Senior Vice President Carolinas HealthCare System 7045122414Haynes, Ken President and Executive Vice President Atrium Health 70435563056/3/2020 8:25 AM
ContactsPrimary ContactUpdateProfile Change RequestPaul-Aviles, Fern Pharmacy Director Carolinas HealthCare System 7046499691Paul-Aviles, Fern Assistant Vice President, Pharmacy Atrium Health 70464996919/12/2019 2:13 PM
AddressesShipping AddressDeleteRecertificationCMC Myers Park Pharmacy 1350 S. Kings Drive Suite 101 Charlotte, NC 28207 9/11/2019 1:39 PM
AddressesShipping AddressDeleteRecertificationCMC Biddle Point Pharmacy 1801 Rozzelles Ferry Road Charlotte, NC 28208 9/11/2019 1:39 PM
AddressesShipping AddressDeleteRecertificationCMC NorthPark Pharmacy 251 Eastway Drive Charlotte, NC 28213 9/11/2019 1:39 PM
AddressesShipping AddressDeleteRecertificationCHS CMC Behavioral Health Pharmacy 501 Billingsley Road Charlotte, NC 28211 9/11/2019 1:39 PM
AddressesShipping AddressInsertRecertification Atrium Health Pharmacy Myers Park 1350 S. Kings Drive Suite 101 Charlotte, NC 282079/11/2019 1:39 PM
AddressesShipping AddressInsertRecertification Atrium Health Pharmacy Biddle Point 1801 Rozzelles Ferry Road Charlotte, NC 282089/11/2019 1:39 PM
AddressesShipping AddressInsertRecertification Atrium Health Pharmacy NorthPark 251 Eastway Drive Charlotte, NC 282139/11/2019 1:39 PM
AddressesShipping AddressInsertRecertification Atrium Health Pharmacy Behavioral 501 Billingsley Road Charlotte, NC 282119/11/2019 1:39 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2019 1:39 PM
Medicaid BillingMedicaid: NumberInsertRecertification 937565349/11/2019 1:39 PM
Medicaid BillingMedicaid: StateInsertRecertification NM9/11/2019 1:39 PM
Medicaid BillingMedicaid: NumberUpdateRecertification0340113Q0506689/11/2019 1:39 PM
Medicaid BillingMedicaid: NumberDeleteRecertification009814159 (VA) 9/11/2019 1:39 PM
Medicaid BillingMedicaid: NumberDeleteRecertification0175950000 (WV) 9/11/2019 1:39 PM
Medicaid BillingMedicaid: NumberUpdateRecertification092547100925471009/11/2019 1:39 PM
Medicaid BillingMedicaid: NumberDeleteRecertificationXHSP41718 (CA) 9/11/2019 1:39 PM
Medicaid BillingMedicaid: NumberUpdateRecertification05482225482229/11/2019 1:39 PM
Medicaid BillingMedicaid: NumberDeleteRecertification100036400A (IN) 9/11/2019 1:39 PM
Medicaid BillingMedicaid: NumberDeleteRecertification110027109B (MA) 9/11/2019 1:39 PM
Medicaid BillingMedicaid: NumberDeleteRecertification406753300 (MN) 9/11/2019 1:39 PM
Medicaid BillingMedicaid: NumberUpdateRecertification016956401169564019/11/2019 1:39 PM
Medicaid BillingMedicaid: NumberUpdateRecertification00097237972379/11/2019 1:39 PM
Medicaid BillingMedicaid: NumberDeleteRecertification4173902 (NJ) 9/11/2019 1:39 PM
Medicaid BillingMedicaid: NumberUpdateRecertification072536801725368019/11/2019 1:39 PM
Medicaid BillingMedicaid: NumberDeleteRecertification561398929004 (UT) 9/11/2019 1:39 PM
Medicaid BillingMedicaid: NumberUpdateRecertification03401133401139/11/2019 1:39 PM
DetailsLast Recertification DateUpdateRecertification9/4/2018 2:00:28 PM9/11/2019 1:39:30 PM9/11/2019 1:39 PM
AddressesShipping AddressInsertChange Request Healthy @ Home Pharmacy - CMC Home Infusion and Equipment 1701 Abbey Place Charlotte, NC 28209-37317/17/2019 7:36 AM
AddressesBilling AddressUpdateChange RequestCarolinas HealthCare System Accounts Payable PO Box 5379 Portland, OR 97228-5379Atrium Health Accounts Payable PO Box 5379 Portland, OR 97228-53797/17/2019 7:36 AM
DetailsLast Recertification DateUpdateRecertification11/29/2017 7:59:06 PM9/4/2018 2:00:28 PM9/4/2018 2:00 PM
AddressesShipping AddressInsertChange Request CMC Pharmacy 1000 Blythe Blvd Charlotte, NC 282037/18/2018 10:53 AM
AddressesShipping AddressInsertChange Request CMC Myers Park Pharmacy 1350 S. Kings Drive Suite 101 Charlotte, NC 282077/18/2018 10:53 AM
AddressesShipping AddressInsertChange Request CMC Biddle Point Pharmacy 1801 Rozzelles Ferry Road Charlotte, NC 282087/18/2018 10:53 AM
AddressesShipping AddressInsertChange Request CMC NorthPark Pharmacy 251 Eastway Drive Charlotte, NC 282137/18/2018 10:53 AM
AddressesShipping AddressInsertChange Request CHS CMC Behavioral Health Pharmacy 501 Billingsley Road Charlotte, NC 282117/18/2018 10:53 AM
AddressesBilling AddressUpdateRecertificationAccounts Payable PO Box 37972 Charlotte, NC 28237Carolinas HealthCare System Accounts Payable PO Box 5379 Portland, OR 97228-537911/29/2017 7:59 PM
DetailsLast Recertification DateUpdateRecertification8/31/2016 12:00:00 AM11/29/2017 7:59:06 PM11/29/2017 7:59 PM
ContactsAuthorizing OfficialUpdate Leighty, Scott Senior Vice President 7045122414Leighty, Scott Senior Vice President Carolinas HealthCare System 704512241410/12/2017 9:08 AM
ContactsPrimary ContactUpdate Paul-Aviles, Fern Pharmacy Director 7046499691Paul-Aviles, Fern Pharmacy Director Carolinas HealthCare System 70464996919/22/2017 2:54 PM
ContactsPrimary ContactUpdate McCoy, Conley Director 7045127637Paul-Aviles, Fern Pharmacy Director 70464996917/25/2017 1:24 PM
ContactsAuthorizing OfficialInsert  Leighty, Scott Senior Vice President 70451224147/25/2017 1:24 PM
AddressesMain AddressInsert   1000 BLYTHE BLVD CHARLOTTE, NC 282037/25/2017 1:24 PM
AddressesBilling AddressInsert  Accounts Payable PO Box 37972 Charlotte, NC 282377/25/2017 1:24 PM
ContactsPrimary ContactInsert  McCoy, Conley Director 70451276377/25/2017 1:24 PM
Medicaid BillingMedicaid: NumberUpdate 092547100009254710010/13/2016 2:27 PM
DetailsLast Recertification DateUpdate 9/1/2015 12:00:00 AM8/31/2016 12:00:00 AM8/31/2016 9:32 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  1253111054/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  AR4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  3205464/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  AZ4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  XHSP417184/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  CA4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  950110114/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  CO4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  0030433874/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  CT4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  0320502004/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  DC4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  05482224/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  IA4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  8074151004/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  ID4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  5613989290014/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  IL4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  100036400A4/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  IN4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  100106450A4/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  KS4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  17484124/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  LA4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  110027109B4/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  MA4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  2179555004/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  MD4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  1792300014/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  ME4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  4067533004/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  MN4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  0169564014/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  MO4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  000972374/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  MS4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  41053354/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  MT4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  561398929004/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  NE4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  200012804/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  NH4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  41739024/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  NJ4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  003506654/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  NY4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  26254764/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  OH4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  10069210A4/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  OK4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  2038494/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  OR4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  10075345300014/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  PA4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  0725368014/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  TX4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  5613989290044/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  UT4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  03401134/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  VT4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  30033164/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  WA4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/15/2016 2:07 PM
Medicaid BillingMedicaid: NumberInsert  806270004/15/2016 2:07 PM
Medicaid BillingMedicaid: StateInsert  WI4/15/2016 2:07 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False10/19/2015 10:02 AM
Medicaid BillingMedicaid: NumberInsert  33668810/19/2015 10:02 AM
Medicaid BillingMedicaid: StateInsert  SC10/19/2015 10:02 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False10/19/2015 10:02 AM
Medicaid BillingMedicaid: NumberInsert  034011310/19/2015 10:02 AM
Medicaid BillingMedicaid: StateInsert  TN10/19/2015 10:02 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False10/19/2015 10:02 AM
Medicaid BillingMedicaid: NumberInsert  00981415910/19/2015 10:02 AM
Medicaid BillingMedicaid: StateInsert  VA10/19/2015 10:02 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False10/19/2015 10:02 AM
Medicaid BillingMedicaid: NumberInsert  017595000010/19/2015 10:02 AM
Medicaid BillingMedicaid: StateInsert  WV10/19/2015 10:02 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False10/19/2015 10:02 AM
Medicaid BillingMedicaid: NumberInsert  000104101A10/19/2015 10:02 AM
Medicaid BillingMedicaid: StateInsert  GA10/19/2015 10:02 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False10/19/2015 10:02 AM
Medicaid BillingMedicaid: NumberInsert  092547100010/19/2015 10:02 AM
Medicaid BillingMedicaid: StateInsert  FL10/19/2015 10:02 AM
DetailsLast Recertification DateUpdate 8/26/2014 12:00:00 AM9/1/2015 12:00:00 AM9/1/2015 2:13 PM
DetailsLast Recertification DateUpdate 9/12/2013 12:00:00 AM8/26/2014 12:00:00 AM8/26/2014 10:48 AM
Medicaid BillingNPI: NumberInsert  12957899071/15/2014 11:46 AM
Medicaid BillingMedicaid: Is PrimaryUpdate TrueFalse9/12/2013 10:56 AM
Medicaid BillingMedicaid: NumberUpdate 060755634001139/12/2013 10:56 AM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/12/2013 12:00:00 AM9/12/2013 10:56 AM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/29/2012 1:46 PM
DetailsComments PublicInsert  3/22/12 Added NPI #; 03/01/2012 ADDRESS 1350 SOUTH KINGS DRIVE MOVED TO CHILD ID (DSH340113D)3/22/2012 1:45 PM
DetailsEntity SubnameUpdate CMC-MYERS PARK 3/1/2012 2:34 PM
DetailsComments PublicInsert  03/01/2012 ADDRESS 1350 SOUTH KINGS DRIVE MOVED TO CHILD ID (DSH340113D)3/1/2012 2:34 PM
DetailsEntity SubnameUpdate CMC-MYERS PARK PHARMACYCMC-MYERS PARK3/1/2012 1:07 PM
DatesParticipating Approval DateUpdate 3/1/2008 6:55:24 AM3/1/2008 12:00:00 AM3/1/2012 1:07 PM
DetailsLast Recertification DateInsert   3/1/2008 6:58 AM
DetailsGrant NumberInsert   3/1/2008 6:58 AM
Details340B IDInsert  DSH3401133/1/2008 6:58 AM
DetailsIs Authorizing Official EHB DataInsert   3/1/2008 6:58 AM
DatesLast Date That 340B Drugs PurchasedInsert   3/1/2008 6:58 AM
DetailsMedicare Provider NumberInsert  3401133/1/2008 6:58 AM
DetailsEntity NameInsert  CAROLINAS MEDICAL CENTER3/1/2008 6:58 AM
DetailsProgram CodeInsert  DSH3/1/2008 6:58 AM
DetailsEntity SubnameInsert  CMC-MYERS PARK PHARMACY3/1/2008 6:58 AM
DatesParticipating Approval DateInsert  3/1/2008 6:55:24 AM3/1/2008 6:58 AM
DetailsStateInsert  Active3/1/2008 6:58 AM
DatesRegistration DateInsert  3/1/2008 12:00:00 AM3/1/2008 6:58 AM
DatesSigned By DateInsert   3/1/2008 6:58 AM
DatesStart DateInsert  8/1/1993 12:00:00 AM3/1/2008 6:58 AM
TerminationsTermination CommentsInsert   3/1/2008 6:58 AM
TerminationsTermination DateInsert   3/1/2008 6:58 AM
TerminationsTermination Effective DateInsert   3/1/2008 6:58 AM
TerminationsTermination ReasonInsert   3/1/2008 6:58 AM
Medicaid BillingMedicaid: Is PrimaryInsert  True3/1/2008 6:48 AM
Medicaid BillingMedicaid: NumberInsert  06075563/1/2008 6:48 AM
Medicaid BillingMedicaid: StateInsert  NC3/1/2008 6:48 AM