Covered Entity Details

DSH340002 MISSION HOSPITALS, INC. (Terminated) - information as of 6/24/2025 12:01:21 AM

Main Details

Name

MISSION HOSPITALS, INC.

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH340002

Medicare Provider Number

340002

Additional Details

Current Program Status

Terminated

Registration Date

4/23/2008

Participating Start Date

7/1/2004

Participating Approval Date

4/23/2008

Last Recertification Date

8/29/2018

Termination Date
Termination Reason

4/1/2019
For-Profit conversion

Contacts

Authorizing Official

Mission Health System
Paul L McDowell, CFO
(828) 213-0184

Primary Contact

Mission Health
Alan K. Knudsen, Pharmacy Specialist, 340B Program
(828) 213-4213

Addresses

Street Address

509 BILTMORE AVENUE
ASHEVILLE, NC 28801

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
12/21/11 ADDED SHIP ADD (AT 501 Biltmore Ave ); 10/26/11 added ship to addr (at 400 ridgefield);6/1/10 SHIP TO ADDR CHANGE (WAS 55-A SHILOH ROAD) 6/07 UPDATED SHIP TO FOR RADIOPHARMACEUTICALS ONLY (WAS SHERTECH PHARMACY SERVICES, 90 SOUTHSIDE AVE, ASHVILLE, NC 28801);11/19/04 REMOVED MEDICAID # AT REQ OF HOSP;04/29/11 ADDED SHIP TO ADDR. (MISSION PHARMACY)	12/21/2011
10/26/11 added ship to addr (at 400 ridgefield);6/1/10 SHIP TO ADDR CHANGE (WAS 55-A SHILOH ROAD) 6/07 UPDATED SHIP TO FOR RADIOPHARMACEUTICALS ONLY (WAS SHERTECH PHARMACY SERVICES, 90 SOUTHSIDE AVE, ASHVILLE, NC 28801);11/19/04 REMOVED MEDICAID # AT REQ OF HOSP;04/29/11 ADDED SHIP TO ADDR. (MISSION PHARMACY)	10/26/2011
6/1/10 SHIP TO ADDR CHANGE (WAS 55-A SHILOH ROAD) 6/07 UPDATED SHIP TO FOR RADIOPHARMACEUTICALS ONLY (WAS SHERTECH PHARMACY SERVICES, 90 SOUTHSIDE AVE, ASHVILLE, NC 28801);11/19/04 REMOVED MEDICAID # AT REQ OF HOSP;04/29/11 ADDED SHIP TO ADDR. (MISSION PHARMACY)	04/29/2011

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
NC	3400002
GA	000146715Z
TN	0340002
SC	213986,191902

Shipping Addresses

Shipping Address 1

Mission Mailorder Pharmacy
400 Ridgefield Court
Asheville, NC 28806

Shipping Address 2

Mission Hospital (DBA: Hope Infusion Pharmacy)
400 Ridgefield Court
Suite 105
Asheville, NC 28806

Shipping Address 3

Mission Hospital's Med Assist Program
1 Hospital Drive
Second Floor, Room 2229
Asheville, NC 28801

Shipping Address 4

Mission My Care Plus - Candler
1388 Sandhill Road
Candler, NC 28715

Shipping Address 5

St. Joseph's Hospital Pharmacy
428 Biltmore Avenue
Asheville, NC 28801

Shipping Address 6

MISSION PHARMACY – CANCER CENTER
21 HOSPITAL DRIVE – FIRST FLOOR
ASHEVILLE, NC 28801

Shipping Address 7

Mission Conmunity Pharmacy
2 Medical Park Drive
Asheville, NC 28803

Shipping Address 8

MISSION HOSPITAL (D.B.A. - RIDGEFIELD PHARMACY)
400 RIDGEFIELD COURT;
SUITE 105
ASHEVILLE, NC 28806

Shipping Address 9

Medical Center Pharmacy
509 Biltmore Ave
Asheville, NC 28801

Shipping Address 10

Mission Pardee Health Campus Pharmacy
2695 Hendersonville Road
Arden, NC 28704

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ABCCM MEDICAL CLINIC PHARMACY	155 LIVINGSTON STREET		ASHEVILLE	NC	28801	09/29/2014	10/01/2014	12/01/2015	07/26/2017
Contract Detail	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	12/04/2017	01/01/2018	04/01/2019	04/01/2019
Contract Detail	BRIOVARX OF MAINE INC	DBA BRIOVARX	53 DARLING AVE	SOUTH PORTLAND	ME	04106	04/17/2017	07/01/2017	04/01/2019	04/01/2019
Contract Detail	BRIOVARX OF MASSACHUSETTS, LLC	D/B/A BRIOVARX	BLDG 2 - UNIT A 145 BODWELL STREET	AVON	MA	02322	04/17/2017	07/01/2017	04/01/2019	04/01/2019
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/12/2017	07/01/2017	04/01/2019	04/01/2019
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/12/2017	07/01/2017	04/01/2019	04/01/2019
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/12/2017	07/01/2017	04/01/2019	04/01/2019
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/12/2017	07/01/2017	04/01/2019	04/01/2019
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/12/2017	07/01/2017	04/01/2019	04/01/2019
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/12/2017	07/01/2017	04/01/2019	04/01/2019
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/12/2017	07/01/2017	04/01/2019	04/01/2019
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/12/2017	07/01/2017	04/01/2019	04/01/2019
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/12/2017	07/01/2017	04/01/2019	04/01/2019
Contract Detail	CVS TN DISTRIBUTION, LLC	10017 KINGSTON PIKE		KNOXVILLE	TN	37922	10/15/2014	01/01/2015	12/01/2015	07/26/2017
Contract Detail	MCDOWELL COMMUNITY PHARMACY	401 Nebo School Rd		Nebo	NC	28761	07/17/2017	10/01/2017	04/01/2019	04/01/2019
Contract Detail	MISSION PHARMACY - BLUE RIDGE	189 Hospital Drive		Spruce Pine	NC	28777	07/17/2017	10/01/2017	04/01/2019	04/01/2019
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03847	505 SMOKEY PARK HWY.	ASHEVILLE	NC	28806	07/05/2013	10/01/2013	10/15/2018	10/15/2018
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04105	1080 HENDERSONVILLE ROAD	ASHEVILLE	NC	28803	07/05/2013	10/01/2013	10/15/2018	10/15/2018
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05586	320 NEW LEICESTER HWY.	ASHEVILLE	NC	28806	07/05/2013	10/01/2013	10/15/2018	10/15/2018
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07007	225 CHARLOTTE HWY SUITE #2	ASHEVILLE	NC	28803	07/05/2013	10/01/2013	10/15/2018	10/15/2018
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07588	612 MERRIMON AVE.	ASHEVILLE	NC	28804	07/05/2013	10/01/2013	10/15/2018	10/15/2018
Contract Detail	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	04/17/2017	07/01/2017	04/01/2019	04/01/2019
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/17/2017	07/01/2017	04/01/2019	04/01/2019
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	04/17/2017	07/01/2017	04/01/2019	04/01/2019
Contract Detail	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	04/17/2017	07/01/2017	04/01/2019	04/01/2019
Contract Detail	OPTUM PHARMACY 800, INC.	3016 GUADALUPE ST STE A		AUSTIN	TX	78705-2861	12/04/2017	01/01/2018	04/01/2019	04/01/2019
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/12/2017	07/01/2017	04/01/2019	04/01/2019
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/08/2015	10/01/2015	04/01/2019	04/01/2019
Contract Detail	WAL-MART PHARMACY 10-1179	60 AIRPORT ROAD		ARDEN	NC	28704	01/14/2016	04/01/2016	04/01/2019	04/01/2019
Contract Detail	WAL-MART PHARMACY 10-1317	125 BLEACHERY BLVD		ASHEVILLE(E)	NC	28805	07/08/2015	10/01/2015	04/01/2019	04/01/2019
Contract Detail	WAL-MART PHARMACY 10-1663	135 TOWN CENTER LOOP		WAYNESVILLE	NC	28786	01/14/2016	04/01/2016	04/01/2019	04/01/2019
Contract Detail	WAL-MART PHARMACY 10-4334	25 NORTH BRIDGE COMMONS PKWY		WEAVERVILLE	NC	28787	01/14/2016	04/01/2016	04/01/2019	04/01/2019
Contract Detail	WAL-MART PHARMACY 10-4428	1636 HENDERSONVILLE RD.		ASHEVILLE	NC	28803	07/08/2015	10/01/2015	04/01/2019	04/01/2019
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/08/2015	10/01/2015	04/01/2019	04/01/2019

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH340002A	Child	DSH	MISSION HOSPITALS, INC.	ASHEVILLE SURGERY CENTER	5 MEDICAL PARK DRIVE	ASHEVILLE	NC	Terminated
DSH340002AA	Child	DSH	MISSION HOSPITALS, INC.	Mission Interventional Spine - Radiology	7 Vanderbilt Park	Asheville	NC	Terminated
DSH340002AB	Child	DSH	MISSION HOSPITALS, INC.	Mission Outpatient Infusion at Hope	100 Ridgefield Court	ASHEVILLE	NC	Terminated
DSH340002AC	Child	DSH	MISSION HOSPITAL INC.	Heart Failure Clinic	5 Vanderbilt Park Drive	Asheville	NC	Terminated
DSH340002AD	Child	DSH	MISSION HOSPITALS, INC.	St. Joseph Hospital / OR Services	428 Biltmore Avenue	Asheville	NC	Terminated
DSH340002AE	Child	DSH	MISSION HOSPITALS, INC.	St. Joseph Hospital / Laboratory Services	428 Biltmore Avenue	Asheville	NC	Terminated
DSH340002AF	Child	DSH	MISSION HOSPITALS, INC.	St. Joseph Hospital / Respiratory Services	428 Biltmore Avenue	Asheville	NC	Terminated
DSH340002AG	Child	DSH	MISSION HOSPITAL INC.	St. Joseph Hospital / Clinic Services	428 Biltmore Avenue	Asheville	NC	Terminated
DSH340002AH	Child	DSH	MISSION HOSPITAL INC.	St. Joseph Hospital / Sub-Provider I	428 Biltmore Avenue	Asheville	NC	Terminated
DSH340002AJ	Child	DSH	MISSION HOSPITALS, INC.	Radiology at Mission My Care Plus Biltmore Park	310 Long Shoals Road	Asheville	NC	Terminated
DSH340002AK	Child	DSH	MISSION HOSPITALS, INC.	St. Joseph Hospital / SJ 5th Floor & 6 North - Pulmonary - Observation	428 Biltmore Avenue	Asheville	NC	Terminated
DSH340002AL	Child	DSH	MISSION HOSPITALS, INC.	St. Joseph Hospital / 7th & 8th Floors & Ortho 6J - Observation	428 Biltmore Avenue	Asheville	NC	Terminated
DSH340002AM	Child	DSH	MISSION HOSPITALS, INC.	St. Joseph Hospital / Critical Care & Stepdown- Observation	428 Biltmore Avenue	Asheville	NC	Terminated
DSH340002AN	Child	DSH	MISSION HOSPITALS, INC.	Radiology Services at Hope Cancer Center	100 Ridgefield Court	Asheville	NC	Terminated
DSH340002AP	Child	DSH	MISSION HOSPITALS, INC.	Cancer Center Radiology Services	21 Hospital Drive	Asheville	NC	Terminated
DSH340002AQ	Child	DSH	MISSION HOSPITALS, INC.	Mission Behavioral Health, Psych Day Program	1 Hospital Drive	Asheville	NC	Terminated
DSH340002AR	Child	DSH	MISSION HOSPITALS, INC.	Reuters Children's Services / Pediatric Endocrinology	11 Vanderbilt Park Drive	Asheville	NC	Terminated
DSH340002AS	Child	DSH	MISSION HOSPITALS, INC.	Mission Children's Clinics / Radiology Services at Reuters	11 Vanderbilt Park	Asheville	NC	Terminated
DSH340002AT	Child	DSH	MISSION HOSPITALS, INC.	Mission Radiology at Sand Hill Road	1388 Sand Hill Road	Candler	NC	Terminated
DSH340002AU	Child	DSH	MISSION HOSPITALS, INC.	Pediatric Comm Transition	11 Vanderbilt Park	Asheville	NC	Terminated
DSH340002AV	Child	DSH	MISSION HOSPITALS, INC.	Hope Cancer Center / PSA	100 Ridgefield Court	Asheville	NC	Terminated
DSH340002AW	Child	DSH	MISSION HOSPITALS, INC.	CCWNC - Cancer Center	21 Hospital Drive, 4th Floor	Asheville	NC	Terminated
DSH340002AX	Child	DSH	MISSION HOSPITALS, INC.	Outpatient Care Center - Clyde / Carolina Spine (CSNC)	360 Hospital Drive	Clyde	NC	Terminated
DSH340002AY	Child	DSH	MISSION HOSPITALS, INC.	Mountain Radiation Oncology	21 Hospital Drive, Lower Level	Asheville	NC	Terminated
DSH340002AZ	Child	DSH	MISSION HOSPITALS, INC.	Outpatient Care Center - Clyde / Asheville Orthopedic Associates - Clyde	360 Hospital Drive	Clyde	NC	Terminated
DSH340002B	Child	DSH	MISSION HOSPITALS, INC.	ST JOSEPHS HOSPITAL	428 BILTMORE AVE	ASHEVILLE	NC	Terminated
DSH340002BA	Child	DSH	MISSION HOSPITALS, INC.	Disease Management	1 Hospital Drive, 3rd Floor	Asheville	NC	Terminated
DSH340002BB	Child	DSH	MISSION HOSPITALS, INC.	Reuters Children's Services / Pediatric Orthopedics	11 Vanderbilt Park Drive	Asheville	NC	Terminated
DSH340002BC	Child	DSH	MISSION HOSPITALS, INC.	Orthopedic Radiology	1 Hospital Drive, 4th Floor	Asheville	NC	Terminated
DSH340002BD	Child	DSH	MISSION HOSPITALS, INC.	Carolina Vascular PSA - 222 Asheland / Ultrasound	222 Asheland	Asheville	NC	Terminated
DSH340002BE	Child	DSH	MISSION HOSPITALS, INC.	222 Asheland Procedure / Carolina Vascular PSA	222 Asheland Avenue	Asheville	NC	Terminated
DSH340002BF	Child	DSH	MISSION HOSPITALS, INC.	Interventional Spine - PSA (WSP)	7 Vanderbilt Park Road	Asheville	NC	Terminated
DSH340002BG	Child	DSH	MISSION HOSPITALS, INC.	Mission CV Diagnostics - Hendersonville	691 Blythe Street	Hendersonville	NC	Terminated
DSH340002BH	Child	DSH	MISSION HOSPITALS, INC.	Mission Breast Center / Mammography	534 Biltmore Avenue	Asheville	NC	Terminated
DSH340002BJ	Child	DSH	MISSION HOSPITALS, INC.	Mission Sleep Center	5 Vanderbilt Park Drive	Asheville	NC	Terminated
DSH340002BK	Child	DSH	MISSION HOSPITALS, INC.	Mission Cancer Center / Multi-Disciplinary Clinic	21 Hospital Drive, 2nd Floor	Asheville	NC	Terminated
DSH340002BL	Child	DSH	MISSION HOSPITALS, INC.	Mammography - 2 Town Square	2 Town Square Blvd., Suite 110	Asheville	NC	Terminated
DSH340002BM	Child	DSH	MISSION HOSPITALS, INC.	Reuters Children's Services / Pediatric Comm Transition	11 Vanderbilt Park Drive	Asheville	NC	Terminated
DSH340002BN	Child	DSH	MISSION HOSPITALS, INC.	Reuters Children's Services / Pediatric Surgery	11 Vanderbilt Park Drive	Asheville	NC	Terminated
DSH340002BP	Child	DSH	MISSION HOSPITALS, INC.	Reuters Children's Services / Pediatric Pulmonology	11 Vanderbilt Park Drive	Asheville	NC	Terminated
DSH340002BQ	Child	DSH	MISSION HOSPITALS, INC.	Mission Hospital / - PACE Program	286 Overlook Road	Asheville	NC	Terminated
DSH340002C	Child	DSH	MISSION HOSPITALS, INC.	Mission Cancer/Infusion Services	21 Hospital Dr., Third Floor	ASHEVILLE	NC	Terminated
DSH340002F	Child	DSH	MISSION HOSPITALS, INC.	MISSION REUTER CHILDREN'S OUTPATIENT CENTER	11 VANDERBILT PARK	ASHEVILLE	NC	Terminated
DSH340002G	Child	DSH	MISSION HOSPITALS, INC.	Mission Health Path and ICR	5 Vanderbilt Park Dr	Asheville	NC	Terminated
DSH340002J	Child	DSH	MISSION HOSPITALS, INC.	Mission Cardiovascular Diagnostics	5 Vanderbilt Park Dr.	Asheville	NC	Terminated
DSH340002K	Child	DSH	MISSION HOSPITALS, INC.	Health Education & Chronic Condition Clinic	1 Hospital Drive, Suites 2201, 3200, 3219 & 3220	Asheville	NC	Terminated
DSH340002L	Child	DSH	MISSION HOSPITALS, INC.	Mission Outpatient Care Center	360 Hospital Dr.	Clyde	NC	Terminated
DSH340002M	Child	DSH	MISSION HOSPITALS, INC.	Outpatient Rehab	534 Biltmore Ave	Asheville	NC	Terminated
DSH340002N	Child	DSH	MISSION HOSPITALS, INC.	Mission Sports Medicine	534 Biltmore Ave	Asheville	NC	Terminated
DSH340002P	Child	DSH	MISSION HOSPITALS, INC.	Mission Rehab Low Vision Center	240 Sardis Rd.	Asheville	NC	Terminated
DSH340002Q	Child	DSH	MISSION HOSPITALS, INC.	Mission Wound Therapy Center	1 Hospital Drive, Suite 4100	Asheville	NC	Terminated
DSH340002R	Child	DSH	MISSION HOSPITALS, INC.	Mission OP Clinical Pharmacy Services	1 Hospital Drive, Suites 3296	Asheville	NC	Terminated
DSH340002T	Child	DSH	MISSION HOSPITALS, INC.	Mission Radiology at Victoria Urological Associates	100 Victoria Rd.	Asheville	NC	Terminated
DSH340002U	Child	DSH	MISSION HOSPITALS, INC.	Mission Olsen Huff Center Practice	11 Vanderbilt Park Drive	Asheville	NC	Terminated
DSH340002V	Child	DSH	MISSION HOSPITALS, INC.	Mission Children's Clinics, Procedure Suite	11 Vanderbilt Park Drive, Suite 2500	Asheville	NC	Terminated
DSH340002W	Child	DSH	MISSION HOSPITALS, INC.	Mission Child Medical Evaluation	11 Vanderbilt Park Drive	Asheville	NC	Terminated
DSH340002X	Child	DSH	MISSION HOSPITALS, INC.	Mission Childrens Clinics, Genetics Center	11 Vanderbilt Park Drive, Suite 1500	Asheville	NC	Terminated
DSH340002Y	Child	DSH	MISSION HOSPITALS, INC.	Mission Pediatric Hematology / Oncology	21 Hospital Drive, 2nd Floor	Asheville	NC	Terminated
DSH340002Z	Child	DSH	MISSION HOSPITALS, INC.	Wound Healing Center	360 Hospital Drive	Clyde	NC	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		1/31/2019 12:00:00 AM	1/30/2019 10:20 AM
Details	State	Update	Termination Request	Active	To Be Terminated	1/30/2019 10:20 AM
Terminations	Termination Comments	Update	Termination Request		Hospital will become a for-profit entity on 2/1/2019 due to acquisition by HCA.	1/30/2019 10:20 AM
Terminations	Termination Date	Update	Termination Request		4/1/2019 12:00:00 AM	1/30/2019 10:20 AM
Terminations	Termination Effective Date	Update	Termination Request		2/1/2019 12:00:00 AM	1/30/2019 10:20 AM
Terminations	Termination Reason	Update	Termination Request		For-Profit conversion	1/30/2019 10:20 AM
Details	Last Recertification Date	Update	Recertification	11/13/2017 11:57:27 AM	8/29/2018 3:49:13 PM	8/29/2018 3:49 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1881626075 ( )		1/25/2018 10:58 AM
Details	Last Recertification Date	Update	Recertification	10/25/2017 10:20:23 AM	11/13/2017 11:57:27 AM	11/13/2017 11:57 AM
Details	Last Recertification Date	Update	Recertification	8/31/2016 12:00:00 AM	10/25/2017 10:20:23 AM	10/25/2017 10:20 AM
Contacts	Authorizing Official	Update		McDowell, Paul CFO 8282130184	McDowell, Paul L CFO Mission Health System 8282130184	10/9/2017 9:20 AM
Contacts	Primary Contact	Update	Profile Change Request	Knudsen, Alan K. Pharmacy Specialist, 340B Program Mission Health 8288134213	Knudsen, Alan K. Pharmacy Specialist, 340B Program Mission Health 8282134213	9/27/2017 4:21 PM
Contacts	Primary Contact	Update		Knudsen, Alan K. Pharmacy Specialist, 340B Program 8288134213	Knudsen, Alan K. Pharmacy Specialist, 340B Program Mission Health 8288134213	9/18/2017 4:44 PM
Contacts	Authorizing Official	Insert			McDowell, Paul CFO 8282130184	8/1/2017 9:19 AM
Contacts	Primary Contact	Update		Randall, John Pharmacy Supply Chain Director 8282577952	Knudsen, Alan K. Pharmacy Specialist, 340B Program 8288134213	8/1/2017 9:19 AM
Addresses	Main Address	Insert			509 BILTMORE AVENUE ASHEVILLE, NC 28801	7/26/2017 3:58 PM
Addresses	Shipping Address	Insert			MISSION HOSPITAL (D.B.A. - RIDGEFIELD PHARMACY) 400 RIDGEFIELD COURT; SUITE 105 ASHEVILLE, NC 28806	7/26/2017 3:58 PM
Addresses	Shipping Address	Insert			MISSION PHARMACY – CANCER CENTER 21 HOSPITAL DRIVE – FIRST FLOOR ASHEVILLE, NC 28801	7/26/2017 3:58 PM
Addresses	Shipping Address	Insert			Mission Mailorder Pharmacy 400 Ridgefield Court Asheville, NC 28806	7/26/2017 3:58 PM
Addresses	Shipping Address	Insert			Medical Center Pharmacy 509 Biltmore Ave Asheville, NC 28801	7/26/2017 3:58 PM
Addresses	Shipping Address	Insert			Mission Conmunity Pharmacy 2 Medical Park Drive Asheville, NC 28803	7/26/2017 3:58 PM
Addresses	Shipping Address	Insert			Mission Hospital (DBA: Hope Infusion Pharmacy) 400 Ridgefield Court Suite 105 Asheville, NC 28806	7/26/2017 3:58 PM
Addresses	Shipping Address	Insert			Mission My Care Plus - Candler 1388 Sandhill Road Candler, NC 28715	7/26/2017 3:58 PM
Addresses	Shipping Address	Insert			Mission Pardee Health Campus Pharmacy 2695 Hendersonville Road Arden, NC 28704	7/26/2017 3:58 PM
Addresses	Shipping Address	Insert			Mission Hospital's Med Assist Program 1 Hospital Drive Second Floor, Room 2229 Asheville, NC 28801	7/26/2017 3:58 PM
Addresses	Shipping Address	Insert			St. Joseph's Hospital Pharmacy 428 Biltmore Avenue Asheville, NC 28801	7/26/2017 3:58 PM
Details	Last Recertification Date	Update		8/6/2015 12:00:00 AM	8/31/2016 12:00:00 AM	8/31/2016 1:27 PM
Details	Last Recertification Date	Update		8/19/2014 12:00:00 AM	8/6/2015 12:00:00 AM	8/6/2015 8:15 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/26/2015 1:19 PM
Medicaid Billing	Medicaid: Number	Insert			000146715Z	7/26/2015 1:19 PM
Medicaid Billing	Medicaid: State	Insert			GA	7/26/2015 1:19 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/26/2015 1:19 PM
Medicaid Billing	Medicaid: Number	Insert			0340002	7/26/2015 1:19 PM
Medicaid Billing	Medicaid: State	Insert			TN	7/26/2015 1:19 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/26/2015 1:19 PM
Medicaid Billing	Medicaid: Number	Insert			213986	7/26/2015 1:19 PM
Medicaid Billing	Medicaid: State	Insert			SC	7/26/2015 1:19 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/26/2015 1:19 PM
Medicaid Billing	Medicaid: Number	Insert			191902	7/26/2015 1:19 PM
Medicaid Billing	Medicaid: State	Insert			SC	7/26/2015 1:19 PM
Medicaid Billing	NPI: Number	Insert			1881626075	7/26/2015 1:19 PM
Details	Last Recertification Date	Update		8/29/2013 12:00:00 AM	8/19/2014 12:00:00 AM	8/19/2014 11:45 AM
Contacts	Primary Contact	Insert			Randall, John Pharmacy Supply Chain Director 8282577952	9/17/2013 3:34 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/29/2013 12:00:00 AM	8/29/2013 3:30 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/29/2012 1:58 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	5/9/2012 9:29 AM
Medicaid Billing	Medicaid: Number	Insert			3400002	5/9/2012 9:29 AM
Medicaid Billing	Medicaid: State	Insert			NC	5/9/2012 9:29 AM
Details	Comments Public	Insert			12/21/11 ADDED SHIP ADD (AT 501 Biltmore Ave ); 10/26/11 added ship to addr (at 400 ridgefield);6/1/10 SHIP TO ADDR CHANGE (WAS 55-A SHILOH ROAD) 6/07 UPDATED SHIP TO FOR RADIOPHARMACEUTICALS ONLY (WAS SHERTECH PHARMACY SERVICES, 90 SOUTHSIDE AVE, ASHVILLE, NC 28801);11/19/04 REMOVED MEDICAID # AT REQ OF HOSP;04/29/11 ADDED SHIP TO ADDR. (MISSION PHARMACY)	12/21/2011 1:28 PM
Details	Comments Public	Insert			10/26/11 added ship to addr (at 400 ridgefield);6/1/10 SHIP TO ADDR CHANGE (WAS 55-A SHILOH ROAD) 6/07 UPDATED SHIP TO FOR RADIOPHARMACEUTICALS ONLY (WAS SHERTECH PHARMACY SERVICES, 90 SOUTHSIDE AVE, ASHVILLE, NC 28801);11/19/04 REMOVED MEDICAID # AT REQ OF HOSP;04/29/11 ADDED SHIP TO ADDR. (MISSION PHARMACY)	10/26/2011 6:00 PM
Details	Last Recertification Date	Insert				4/29/2011 2:11 PM
Details	Grant Number	Insert				4/29/2011 2:11 PM
Details	340B ID	Insert			DSH340002	4/29/2011 2:11 PM
Details	Is Authorizing Official EHB Data	Insert				4/29/2011 2:11 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/29/2011 2:11 PM
Details	Medicare Provider Number	Insert			340002	4/29/2011 2:11 PM
Details	Entity Name	Insert			MISSION HOSPITALS, INC.	4/29/2011 2:11 PM
Details	Program Code	Insert			DSH	4/29/2011 2:11 PM
Details	Entity Subname	Insert				4/29/2011 2:11 PM
Dates	Participating Approval Date	Insert			4/23/2008 12:00:00 AM	4/29/2011 2:11 PM
Details	State	Insert			Active	4/29/2011 2:11 PM
Dates	Registration Date	Insert			4/23/2008 12:00:00 AM	4/29/2011 2:11 PM
Dates	Signed By Date	Insert				4/29/2011 2:11 PM
Dates	Start Date	Insert			7/1/2004 12:00:00 AM	4/29/2011 2:11 PM
Terminations	Termination Comments	Insert				4/29/2011 2:11 PM
Terminations	Termination Date	Insert				4/29/2011 2:11 PM
Terminations	Termination Effective Date	Insert				4/29/2011 2:11 PM
Terminations	Termination Reason	Insert				4/29/2011 2:11 PM
Details	Comments Public	Insert			6/1/10 SHIP TO ADDR CHANGE (WAS 55-A SHILOH ROAD) 6/07 UPDATED SHIP TO FOR RADIOPHARMACEUTICALS ONLY (WAS SHERTECH PHARMACY SERVICES, 90 SOUTHSIDE AVE, ASHVILLE, NC 28801);11/19/04 REMOVED MEDICAID # AT REQ OF HOSP;04/29/11 ADDED SHIP TO ADDR. (MISSION PHARMACY)	4/29/2011 2:11 PM