Covered Entity Details

DSH340145B Atrium Health Lincoln (Terminated) - information as of 6/6/2025 12:28:18 PM

Main Details

Name

Atrium Health Lincoln

Subdivision Name

Atrium Health Pain Management, a facility of Atrium Health Lincoln

Type

Disproportionate Share Hospital

Rural

340B ID

DSH340145B

Medicare Provider Number

340145

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/15/2013

Participating Start Date

10/1/2013

Participating Approval Date

9/13/2013

Last Recertification Date

9/14/2020

Termination Date
Termination Reason

10/1/2021
DSH percentage below statutory minimum

Contacts

Authorizing Official

Atrium Health
Don McCoy Mabe, VP, Pharmacy
(704) 512-7623

Primary Contact

Atrium Health
Fern Paul-Aviles, AVP, Pharmacy
(704) 649-9691

Addresses

Street Address

1585 Forney Creek Parkway
Suite 1200
Denver, NC 28037

Billing Address

Atrium Health Accounts Payable
PO Box 5379
Portland, OR 97228-5379

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
MA	110154231D
TN	Q029806
CT	008078633
FL	0047816,4781600
NM	44631405
PA	1028774040001
GA	003118507B
VA		1326088139
NC		1326088139

Shipping Addresses

Shipping Address 1

Atrium Health Lincoln Pharmacy
433 McAlister Rd
Lincolnton, NC 28092

Shipping Address 2

Atrium Health Pain Management
1585 Forney Creek Parkway
Suite 1200
Denver, NC 28037

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
DSH340145A	Child	DSH	Atrium Health Lincoln	Atrium Health Surgery Center, a facility of Atrium Health Lincoln	1585 Forney Creek Parkway	Denver	NC	Terminated
DSH340145B	Child	DSH	Atrium Health Lincoln	Atrium Health Pain Management, a facility of Atrium Health Lincoln	1585 Forney Creek Parkway	Denver	NC	Terminated
DSH340145C	Child	DSH	Atrium Health Lincoln	Lincoln Infusion Center, a facility of Atrium Health Lincoln	447 McAlister Road	Lincolnton	NC	Terminated
DSH340145D	Child	DSH	Atrium Health Lincoln	Levine Cancer Institute Medical Oncology Clinic (330700)	447 McAlister Road	Lincolnton	NC	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Mabe, Don McCoy Chief Pharmacy Officer Atrium Health 7045127623	Mabe, Don McCoy VP, Pharmacy Atrium Health 7045127623	8/13/2024 2:16 PM
Details	State	Update		To Be Terminated	Terminated	10/1/2021 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		7/29/2021 12:00:00 AM	8/9/2021 7:54 AM
Details	State	Update	Termination Request	Active	To Be Terminated	8/9/2021 7:54 AM
Terminations	Termination Date	Update	Termination Request		10/1/2021 12:00:00 AM	8/9/2021 7:54 AM
Terminations	Termination Effective Date	Update	Termination Request		8/1/2021 12:00:00 AM	8/9/2021 7:54 AM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	8/9/2021 7:54 AM
Addresses	Shipping Address	Insert	Recertification		Atrium Health Pain Management 1585 Forney Creek Parkway Suite 1200 Denver, NC 28037	9/14/2020 6:53 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	3400145 (NC)		9/14/2020 6:53 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/14/2020 6:53 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		008078633	9/14/2020 6:53 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		CT	9/14/2020 6:53 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/14/2020 6:53 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0047816	9/14/2020 6:53 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/14/2020 6:53 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/14/2020 6:53 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		44631405	9/14/2020 6:53 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NM	9/14/2020 6:53 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/14/2020 6:53 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1028774040001	9/14/2020 6:53 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/14/2020 6:53 AM
Medicaid Billing	NPI: State	Update	Recertification		VA	9/14/2020 6:53 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1326088139	9/14/2020 6:53 AM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/14/2020 6:53 AM
Contacts	Primary Contact	Update	Recertification	Paul-Aviles, Fern Assistant Vice President, Pharmacy Atrium Health 7046499691	Paul-Aviles, Fern AVP, Pharmacy Atrium Health 7046499691	9/14/2020 6:53 AM
Details	Last Recertification Date	Update	Recertification	9/13/2019 8:45:46 AM	9/14/2020 6:53:01 AM	9/14/2020 6:53 AM
Contacts	Authorizing Official	Update	AO Change Request	Haynes, Ken President and Executive Vice President Atrium Health 7043556305	Mabe, Don McCoy Chief Pharmacy Officer Atrium Health 7045127623	8/14/2020 7:56 AM
Contacts	Authorizing Official	Update	Change Request	Leighty, Scott Senior Vice President Carolinas HealthCare System 7045122414	Haynes, Ken President and Executive Vice President Atrium Health 7043556305	6/3/2020 8:24 AM
Addresses	Shipping Address	Delete	Recertification	CHS Lincoln Pharmacy 433 McAlister Rd Lincolnton, NC 28092		9/13/2019 8:45 AM
Addresses	Shipping Address	Insert	Recertification		Atrium Health Lincoln Pharmacy 433 McAlister Rd Lincolnton, NC 28092	9/13/2019 8:45 AM
Addresses	Billing Address	Update	Recertification	Carolinas HealthCare System Accounts Payable PO Box 5379 Portland, OR 97228-5379	Atrium Health Accounts Payable PO Box 5379 Portland, OR 97228-5379	9/13/2019 8:45 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/13/2019 8:45 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		110154231D	9/13/2019 8:45 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MA	9/13/2019 8:45 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/13/2019 8:45 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		Q029806	9/13/2019 8:45 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		TN	9/13/2019 8:45 AM
Medicaid Billing	Medicaid: Number	Update	Recertification	004781600	4781600	9/13/2019 8:45 AM
Details	Last Recertification Date	Update	Recertification	9/5/2018 9:41:46 AM	9/13/2019 8:45:46 AM	9/13/2019 8:45 AM
Details	Entity Subname	Update	Recertification	CHS Pain Management, a facility of Carolinas HealthCare System Lincoln	Atrium Health Pain Management, a facility of Atrium Health Lincoln	9/13/2019 8:45 AM
Contacts	Primary Contact	Update	Profile Change Request	Paul-Aviles, Fern Pharmacy Director Carolinas HealthCare System 7046499691	Paul-Aviles, Fern Assistant Vice President, Pharmacy Atrium Health 7046499691	9/12/2019 2:13 PM
Details	Entity Name	Update	Change Request	Carolinas HealthCare System Lincoln	Atrium Health Lincoln	1/9/2019 1:22 PM
Addresses	Shipping Address	Insert	Recertification		CHS Lincoln Pharmacy 433 McAlister Rd Lincolnton, NC 28092	9/5/2018 9:41 AM
Addresses	Shipping Address	Delete	Recertification	CHS-Lincoln 433 McAlister Rd Lincolnton, NC 28092		9/5/2018 9:41 AM
Details	Last Recertification Date	Update	Recertification	11/29/2017 8:31:35 PM	9/5/2018 9:41:46 AM	9/5/2018 9:41 AM
Addresses	Billing Address	Update	Recertification	Accounts Payable PO Box 37972 Charlotte, NC 28237	Carolinas HealthCare System Accounts Payable PO Box 5379 Portland, OR 97228-5379	11/29/2017 8:31 PM
Details	Last Recertification Date	Update	Recertification	8/31/2016 12:00:00 AM	11/29/2017 8:31:35 PM	11/29/2017 8:31 PM
Contacts	Authorizing Official	Update		Leighty, Scott Senior Vice President 7045122414	Leighty, Scott Senior Vice President Carolinas HealthCare System 7045122414	10/12/2017 9:08 AM
Contacts	Primary Contact	Update		Paul-Aviles, Fern Pharmacy Director 7046499691	Paul-Aviles, Fern Pharmacy Director Carolinas HealthCare System 7046499691	9/22/2017 2:54 PM
Contacts	Primary Contact	Insert			Paul-Aviles, Fern Pharmacy Director 7046499691	7/25/2017 1:24 PM
Contacts	Authorizing Official	Insert			Leighty, Scott Senior Vice President 7045122414	7/25/2017 1:24 PM
Contacts	Signed By	Insert			Knox, John J. Chief Administrative Officer 7043551116	7/25/2017 1:24 PM
Addresses	Main Address	Insert			1585 Forney Creek Parkway Suite 1200 Denver, NC 28037	11/3/2016 7:23 AM
Addresses	Billing Address	Insert			Accounts Payable PO Box 37972 Charlotte, NC 28237	11/3/2016 7:23 AM
Addresses	Shipping Address	Insert			CHS-Lincoln 433 McAlister Rd Lincolnton, NC 28092	11/3/2016 7:23 AM
Details	Last Recertification Date	Update		9/1/2015 12:00:00 AM	8/31/2016 12:00:00 AM	8/31/2016 9:50 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/19/2015 9:26 AM
Medicaid Billing	Medicaid: Number	Insert			003118507B	10/19/2015 9:26 AM
Medicaid Billing	Medicaid: State	Insert			GA	10/19/2015 9:26 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/19/2015 9:26 AM
Medicaid Billing	Medicaid: Number	Insert			004781600	10/19/2015 9:26 AM
Medicaid Billing	Medicaid: State	Insert			FL	10/19/2015 9:26 AM
Details	Last Recertification Date	Update		8/26/2014 12:00:00 AM	9/1/2015 12:00:00 AM	9/1/2015 2:36 PM
Details	Entity Name	Update		CAROLINAS MEDICAL CENTER - LINCOLN	Carolinas HealthCare System Lincoln	10/21/2014 6:53 PM
Details	Entity Subname	Update		CMC-Lincoln Pain Center	CHS Pain Management, a facility of Carolinas HealthCare System Lincoln	10/21/2014 6:53 PM
Details	Last Recertification Date	Update			8/26/2014 12:00:00 AM	8/26/2014 1:38 PM
Medicaid Billing	NPI: Number	Insert			1326088139	7/17/2014 9:50 AM
Dates	Participating Approval Date	Update			9/13/2013 12:00:00 AM	9/13/2013 12:49 PM
Details	State	Update		Pending	Active	9/13/2013 12:49 PM
Dates	Start Date	Update			10/1/2013 12:00:00 AM	9/13/2013 12:49 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH340145B	8/13/2013 3:13 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/15/2013 3:37 PM
Medicaid Billing	Medicaid: Number	Insert			3400145	7/15/2013 3:37 PM
Medicaid Billing	Medicaid: State	Insert			NC	7/15/2013 3:37 PM
Details	Last Recertification Date	Insert				7/15/2013 3:37 PM
Details	Grant Number	Insert				7/15/2013 3:37 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	7/15/2013 3:37 PM
Details	Is Authorizing Official EHB Data	Insert				7/15/2013 3:37 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/15/2013 3:37 PM
Details	Medicare Provider Number	Insert			340145	7/15/2013 3:37 PM
Details	Entity Name	Insert			CAROLINAS MEDICAL CENTER - LINCOLN	7/15/2013 3:37 PM
Details	Program Code	Insert			DSH	7/15/2013 3:37 PM
Details	Entity Subname	Insert			CMC-Lincoln Pain Center	7/15/2013 3:37 PM
Dates	Participating Approval Date	Insert				7/15/2013 3:37 PM
Details	State	Insert			Pending	7/15/2013 3:37 PM
Dates	Registration Date	Insert			7/15/2013 12:00:00 AM	7/15/2013 3:37 PM
Dates	Signed By Date	Insert			7/15/2013 12:00:00 AM	7/15/2013 3:37 PM
Dates	Start Date	Insert				7/15/2013 3:37 PM
Terminations	Termination Comments	Insert				7/15/2013 3:37 PM
Terminations	Termination Date	Insert				7/15/2013 3:37 PM
Terminations	Termination Effective Date	Insert				7/15/2013 3:37 PM
Terminations	Termination Reason	Insert				7/15/2013 3:37 PM