Covered Entity Details

CAH341326-03 Angel Medical Center (Terminated) - information as of 6/9/2025 11:02:25 PM

Main Details

Name

Angel Medical Center

Subdivision Name

Angel Pediatrics

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH341326-03

Medicare Provider Number

341326

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/11/2012

Participating Start Date

1/1/2013

Participating Approval Date

10/31/2012

Last Recertification Date

9/6/2018

Termination Date
Termination Reason

4/1/2019
For-Profit conversion

Contacts

Authorizing Official

Angel Medical Center
Karen Gorby, President & CNO
(828) 369-4232

Primary Contact

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

Addresses

Street Address

56 Medical Park Drive
Franklin, NC 28734

Billing Address

Angel Medical Center
P.O. Box 1209
Franklin, NC 28744-1209

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

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

State	Medicaid Number	NPI Number
NC	34-01326
GA	000352602A
		1902059173

Shipping Addresses

Shipping Address 1

Angel Medical Center
120 Riverview Street
Franklin, NC 28734

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH341326-01	Child	CAH	Angel Medical Center	My Care Now - Franklin	190 Riverview Street	Franklin	NC	Terminated
CAH341326-02	Child	CAH	Angel Medical Center	Mission Health Center Franklin - Rural Health Clinic	190 Riverview Street	Franklin	NC	Terminated
CAH341326-03	Child	CAH	Angel Medical Center	Angel Pediatrics	56 Medical Park Drive	Franklin	NC	Terminated
CAH341326-04	Child	CAH	Angel Medical Center	Angel Surgical Associates	190 Riverview Street	Franklin	NC	Terminated
CAH341326-05	Child	CAH	Angel Medical Center	Angel Orthopedics	56 Medical Park Drive, Suite 302	Franklin	NC	Terminated
CAH341326-06	Child	CAH	Angel Medical Center	Angel Women's - Franklin	56 Medical Park Drive	Franklin	NC	Terminated
CAH341326-07	Child	CAH	Angel Medical Center	Angel Outpatient Infusion Center	834 Depot Street	Franklin	NC	Terminated
CAH341326-08	Child	CAH	ANGEL MEDICAL CENTER	Mission Women's Care Sylva / RHC	111 CENTRAL STREET	SYLVA	NC	Terminated
CAH341326-09	Child	CAH	Angel Medical Center	ANGEL PHYSICIAN PRACTICE / Angel Orthopaedic Associates	56 MEDICAL PARK DR	FRANKLIN	NC	Terminated
CAH341326-10	Child	CAH	Angel Medical Center	Angel Medical Center Pain Clinic / Pain Management	120 Riverview Street	Franklin	NC	Terminated
CAH341326-11	Child	CAH	Angel Medical Center	Angel Medical Center - Cancer Care of Western North Carolina	834 Depot Street	Franklin	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 4:11 PM
Details	State	Update	Termination Request	Active	To Be Terminated	1/30/2019 4:11 PM
Terminations	Termination Comments	Update	Termination Request		On 2/1/2019 this hospital will be purchased by HCA and become a for-profit entity.	1/30/2019 4:11 PM
Terminations	Termination Date	Update	Termination Request		4/1/2019 12:00:00 AM	1/30/2019 4:11 PM
Terminations	Termination Effective Date	Update	Termination Request		2/1/2019 12:00:00 AM	1/30/2019 4:11 PM
Terminations	Termination Reason	Update	Termination Request		For-Profit conversion	1/30/2019 4:11 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1902059173	9/6/2018 3:47 PM
Details	Last Recertification Date	Update	Recertification	11/6/2017 2:00:29 PM	9/6/2018 3:47:44 PM	9/6/2018 3:47 PM
Addresses	Main Address	Update	Change Request	56 Medical Park Drive Suite 204 Franklin, NC 28734	56 Medical Park Drive Franklin, NC 28734	4/17/2018 8:50 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1902059173 ( )		1/26/2018 9:19 AM
Contacts	Primary Contact	Update	Change Request	Cowan, Debby Pharmacy Manager Angel Medical Center 8283496851	Knudsen, Alan K. Pharmacy Specialist, 340B Program Mission Health 8282134213	12/12/2017 9:26 AM
Details	Last Recertification Date	Update	Recertification	9/1/2016 12:00:00 AM	11/6/2017 2:00:29 PM	11/6/2017 2:00 PM
Contacts	Primary Contact	Update	Recertification	Cowan, Debby Pharmacy Manager 8283496851	Cowan, Debby Pharmacy Manager Angel Medical Center 8283496851	11/6/2017 1:51 PM
Contacts	Authorizing Official	Update		Gorby, Karen President & CNO 8283694232	Gorby, Karen President & CNO Angel Medical Center 8283694232	11/6/2017 1:42 PM
Contacts	Authorizing Official	Update		Bednarek, Robert Interim President 8283694232	Gorby, Karen President & CNO 8283694232	5/31/2017 7:19 AM
Contacts	Signed By	Insert			Price, Sheila CNO 8283496886	5/31/2017 7:19 AM
Contacts	Primary Contact	Insert			Cowan, Debby Pharmacy Manager 8283496851	5/31/2017 7:19 AM
Addresses	Main Address	Insert			56 Medical Park Drive Suite 204 Franklin, NC 28734	4/20/2017 3:03 PM
Addresses	Billing Address	Insert			Angel Medical Center P.O. Box 1209 Franklin, NC 28744-1209	4/20/2017 3:03 PM
Addresses	Shipping Address	Insert			Angel Medical Center 120 Riverview Street Franklin, NC 28734	4/20/2017 3:03 PM
Details	Last Recertification Date	Update		8/25/2015 12:00:00 AM	9/1/2016 12:00:00 AM	9/1/2016 2:30 PM
Contacts	Authorizing Official	Insert			Bednarek, Robert Interim President 8283694232	4/20/2016 3:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/25/2015 8:26 AM
Medicaid Billing	Medicaid: Number	Insert			000352602A	8/25/2015 8:26 AM
Medicaid Billing	Medicaid: State	Insert			GA	8/25/2015 8:26 AM
Details	Last Recertification Date	Update		8/20/2014 12:00:00 AM	8/25/2015 12:00:00 AM	8/25/2015 8:26 AM
Details	Last Recertification Date	Update		9/4/2013 12:00:00 AM	8/20/2014 12:00:00 AM	8/20/2014 2:59 PM
Details	Entity Subname	Update		Community Pediatrics	Angel Pediatrics	6/11/2014 1:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	5/13/2014 12:50 PM
Medicaid Billing	Medicaid: Number	Insert			34-01326	5/13/2014 12:50 PM
Medicaid Billing	Medicaid: State	Insert			NC	5/13/2014 12:50 PM
Medicaid Billing	NPI: Number	Insert			1902059173	5/13/2014 12:50 PM
Details	Last Recertification Date	Update			9/4/2013 12:00:00 AM	9/4/2013 6:57 AM
Details	340B ID	Update		ISDMCAH341326-03	CAH341326-03	10/31/2012 5:04 PM
Dates	Participating Approval Date	Update			10/31/2012 12:00:00 AM	10/31/2012 5:04 PM
Details	State	Update		Pending	Active	10/31/2012 5:04 PM
Dates	Start Date	Update			1/1/2013 12:00:00 AM	10/31/2012 5:04 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	ISDMCAH341326-03	10/31/2012 4:07 PM
Details	Last Recertification Date	Insert				10/11/2012 11:22 AM
Details	Grant Number	Insert				10/11/2012 11:22 AM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	10/11/2012 11:22 AM
Details	Is Authorizing Official EHB Data	Insert				10/11/2012 11:22 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/11/2012 11:22 AM
Details	Medicare Provider Number	Insert			341326	10/11/2012 11:22 AM
Details	Entity Name	Insert			Angel Medical Center	10/11/2012 11:22 AM
Details	Program Code	Insert			CAH	10/11/2012 11:22 AM
Details	Entity Subname	Insert			Community Pediatrics	10/11/2012 11:22 AM
Dates	Participating Approval Date	Insert				10/11/2012 11:22 AM
Details	State	Insert			Pending	10/11/2012 11:22 AM
Dates	Registration Date	Insert			10/11/2012 12:00:00 AM	10/11/2012 11:22 AM
Dates	Signed By Date	Insert			10/11/2012 12:00:00 AM	10/11/2012 11:22 AM
Dates	Start Date	Insert				10/11/2012 11:22 AM
Terminations	Termination Comments	Insert				10/11/2012 11:22 AM
Terminations	Termination Date	Insert				10/11/2012 11:22 AM
Terminations	Termination Effective Date	Insert				10/11/2012 11:22 AM
Terminations	Termination Reason	Insert				10/11/2012 11:22 AM