Covered Entity Details

DSH340061AT UNC Hospitals (Terminated) - information as of 6/2/2025 8:28:54 AM

Main Details

Name

UNC Hospitals

Subdivision Name

UNC Hospital Surgery Center at Conner Drive

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH340061AT

Medicare Provider Number

340061

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/14/2014

Participating Start Date

4/1/2014

Participating Approval Date

2/11/2014

Last Recertification Date

8/20/2014

Termination Date
Termination Reason

10/1/2015
Site closure

Contacts

Authorizing Official

UNC Hospitals
Benjamin Rowell Daniels, Chief Operating Officer
(984) 974-7744

Primary Contact

Sarah Lee, Pharmacy Clinical Manager
(984) 974-6652

Addresses

Street Address

109 Conner Drive
Chapel Hill, NC 27514

Billing Address

UNC Hospitals
101 Manning Drive
Chapel Hill, NC 27514

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	3400061
		1932208576

Shipping Addresses

Shipping Address 1

UNC Hospitals
101 Manning Drive
Chapel Hill, NC 27514

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
DSH340061A	Child	DSH	UNC Hospitals	Ambulatory Surgery Center	102 Mason Farm Road	Chapel Hill	NC	Active
DSH340061AB	Child	DSH	UNC Hospitals	UNC Hospitals Outpatient Center at Eastowne - Laboratory	100 Eastowne Drive	Chapel Hill	NC	Terminated
DSH340061AC	Child	DSH	UNC Hospitals	UNC Hospitals Cardiac Rehabilitation	100 Sprunt St	Chapel Hill	NC	Active
DSH340061AD	Child	DSH	UNC Hospitals	UNC Hospitals Benign Hematology at Eastowne	100 Eastowne Dr.	Chapel Hill	NC	Active
DSH340061AE	Child	DSH	UNC Hospitals	UNC Hospitals Pain Management Center	6330 Quadrangle Drive	Chapel Hill	NC	Active
DSH340061AF	Child	DSH	UNC Hospitals	UNC Hospitals Spine Center & Neurosurgery Clinic – Spine Center	1350 RALEIGH RD	Chapel Hill	NC	Active
DSH340061AH	Child	DSH	UNC Hospitals	UNC Hospitals Alcohol & Substance Abuse Program	1101 Weaver Dairy Rd	Chapel Hill	NC	Terminated
DSH340061AJ	Child	DSH	UNC Hospitals	UNC Hospitals Hearing and Voice Center at Carolina Crossing	2226 Nelson Highway	Chapel Hill	NC	Terminated
DSH340061AM	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus – Diagnostic Radiology	430 Waterstone Drive	Hillsborough	NC	Terminated
DSH340061AN	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus – Ultrasound	430 Waterstone Drive	Hillsborough	NC	Terminated
DSH340061AP	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus – Mammography	430 Waterstone Drive	Hillsborough	NC	Terminated
DSH340061AQ	Child	DSH	UNC Hospitals	UNC Hospitals Carolina Pointe II Orthopedic Radiology	6011 Farrington Road	Chapel Hill	NC	Terminated
DSH340061AR	Child	DSH	UNC Hospitals	UNC Hospitals Carolina Pointe II Radiology	6013 Farrington Road	Chapel Hill	NC	Terminated
DSH340061AS	Child	DSH	UNC Hospitals	UNC Hosptials ACC Radiology	102 Mason Farm Road	Chapel Hill	NC	Active
DSH340061AT	Child	DSH	UNC Hospitals	UNC Hospital Surgery Center at Conner Drive	109 Conner Drive	Chapel Hill	NC	Terminated
DSH340061AU	Child	DSH	UNC Hospitals	UNC Homecare Specialists A Department of UNC Hospitals	4400 Emperor Blvd	Durham	NC	Active
DSH340061AV	Child	DSH	UNC Hospitals	UNC Hospitals Therapeutic Infusion at Eastowne	100 Eastowne Dr.	CHAPEL HILL	NC	Active
DSH340061AW	Child	DSH	UNC Hospitals	UNC Hospitals Rehabilitation Therapies – Occupational Therapy	1807 N. Fordham Boulevard	Chapel Hill	NC	Terminated
DSH340061AX	Child	DSH	UNC Hospitals	UNC Hospitals Rehabilitation Therapies – Physical Therapy	1807 N. Fordham Boulevard	Chapel Hill	NC	Terminated
DSH340061AY	Child	DSH	UNC Hospitals	UNC Hospitals Rehabilitation Therapies – Speech Therapy	1807 N. Fordham Boulevard	Chapel Hill	NC	Terminated
DSH340061AZ	Child	DSH	UNC Hospitals	UNC Hospitals Oncology Hillsborough Campus	460 Waterstone Drive	Hillsborough	NC	Active
DSH340061B	Child	DSH	UNC Hospitals	UNC Hospitals Nephrology at Eastowne	100 Eastowne Dr.	Chapel Hill	NC	Active
DSH340061BA	Child	DSH	UNC Hospitals	UNC Hospitals Urology at Eastowne	100 Eastowne Dr.	Chapel Hill	NC	Terminated
DSH340061BB	Child	DSH	UNC Hospitals	Vascular Interventional Radiology (VIR)	300 Meadowmont Village Circle	Chapel Hill	NC	Active
DSH340061BC	Child	DSH	UNC Hospitals	UNC HOSPITALS IMAGING CENTER	1350 RALEIGH RD	CHAPEL HILL	NC	Active
DSH340061BD	Child	DSH	UNC Hospitals	UNC HOSPITALS AMBULATORY SURGERY CE / ACC Children's Short Stay	102 MASON FARM RD	CHAPEL HILL	NC	Terminated
DSH340061BE	Child	DSH	UNIVERSITY OF NORTH CAROLINA HOSP.	ACC Pulmonary Diagnostic Services	102 Mason Farm Road	Chapel Hill	NC	Terminated
DSH340061BF	Child	DSH	UNIVERSITY OF NORTH CAROLINA HOSP.	UNC HOSPITALS AMBULATORY SURGERY CE / ACC Ultrasound	102 MASON FARM RD	CHAPEL HILL	NC	Terminated
DSH340061BG	Child	DSH	UNC Hospitals	UNC Hospitals Heart & Vascular Center at Meadowmont - Vascular & Wound Center	300 Meadowmont Village Circle	Chapel Hill	NC	Terminated
DSH340061BH	Child	DSH	UNC Hospitals	Audiology Carolina Crossing	2226 Nelson Highway	Chapel Hill	NC	Terminated
DSH340061BJ	Child	DSH	UNIVERSITY OF NORTH CAROLINA HOSP.	UNC HOSPITALS AMBULATORY SURGERY CE / ACC MRI Facility	102 MASON FARM RD	CHAPEL HILL	NC	Terminated
DSH340061BK	Child	DSH	UNC Hospitals	UNC Hospitals Imaging Center	1350 Raleigh Rd	Chapel Hill	NC	Active
DSH340061BL	Child	DSH	UNIVERSITY OF NORTH CAROLINA HOSP.	UNC HOSPITALS AMBULATORY SURGERY CE / ACC EKG	102 MASON FARM RD	CHAPEL HILL	NC	Terminated
DSH340061BM	Child	DSH	UNIVERSITY OF NORTH CAROLINA HOSP.	UNC HOSPITALS AMBULATORY SURGERY CE / ACC Computerized Tomography	102 MASON FARM RD	CHAPEL HILL	NC	Terminated
DSH340061BN	Child	DSH	UNC Hospitals	UNC Hospitals Gastroenterology at Eastowne	100 Eastowne Dr.	Chapel Hill	NC	Active
DSH340061BP	Child	DSH	UNC Hospitals	UNC Hospitals Wound Healing & Podiatry Center	300 Meadowmont Village Circle	Chapel Hill	NC	Terminated
DSH340061BQ	Child	DSH	UNC Hospitals	UNC HOSPITALS FAMILY MEDICINE CENTER - Radiology	590 MANNING DRIVE	CHAPEL HILL	NC	Terminated
DSH340061BR	Child	DSH	UNC Hospitals	MCCREARY CANCER CENTER, A SER	212 MULBERRY STREET, SW	LENOIR	NC	Active
DSH340061BS	Child	DSH	UNC Hospitals	UNC HOSPITALS NEUROLOGY CLINIC	300 Meadowmont Village Circle	Chapel Hill	NC	Active
DSH340061BT	Child	DSH	UNC Hospitals	UNC Hospitals Pain Management and Neurosurgery Hillsborough Campus – Chronic Pain	460 Waterstone Drive	Hillsborough	NC	Terminated
DSH340061BU	Child	DSH	UNC Hospitals	UNC Hospitals Pain Management and Neurosurgery Hillsborough Campus –Spine & Neurosurgery	460 Waterstone Drive	Hillsborough	NC	Terminated
DSH340061BV	Child	DSH	UNC Hospitals	UNC Hospitals Therapeutic Infusion Center at Pittsboro	75 Freedom Parkway, Suite B	Pittsboro	NC	Active
DSH340061BW	Child	DSH	UNC Hospitals	UNC Hospitals Hematology Oncology High Point	302 Westwood Avenue	High Point	NC	Terminated
DSH340061BX	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus - Physical Therapy	430 Waterstone Drive	Hillsborough	NC	Terminated
DSH340061BY	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus - Occupational Therapy	430 Waterstone Dr	Hillsborough	NC	Terminated
DSH340061BZ	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus - EP Cardiac Services	430 Waterstone Dr	Hillsborough	NC	Terminated
DSH340061C	Child	DSH	UNC Hospitals	UNCH GERIATRIC SPECIALTY CLINIC	6011 Farrington Road	Chapel Hill	NC	Terminated
DSH340061CA	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus - MRI	430 Waterstone Dr	Hillsborough	NC	Active
DSH340061CB	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus - Observation Unit	430 Waterstone Drive	Hillsborough	NC	Terminated
DSH340061CC	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus - Emergency Dept	430 Waterstone Drive	Hillsborough	NC	Active
DSH340061CD	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus - Nuclear Medicine	430 Waterstone Drive	Hillsborough	NC	Terminated
DSH340061CE	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus - Respiratory Therapy	430 Waterstone Drive	Hillsborough	NC	Terminated
DSH340061CF	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus - Anesthesia Support	430 Waterstone Drive	Hillsborough	NC	Terminated
DSH340061CG	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus - Pre-op/PACU	430 Waterstone Drive	Hillsborough	NC	Terminated
DSH340061CH	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus - Operating Room	430 Waterstone Drive	Hillsborough	NC	Active
DSH340061CJ	Child	DSH	UNC Hospitals	UNC Hospitals Radiation Oncology High Point	302 Westwood Avenue	High Point	NC	Terminated
DSH340061CK	Child	DSH	UNC Hospitals	UNC Hospitals Infusion at High Point	302 Westwood Avenue	High Point	NC	Terminated
DSH340061CL	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus - ICU Observation	430 Waterstone Dr	Hillsborough	NC	Terminated
DSH340061CM	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus - Med/Surg 4 Observation	430 Waterstone Drive	Hillsborough	NC	Terminated
DSH340061CN	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus - Med/Surg 3 Observation	430 Waterstone Drive	Hillsborough	NC	Terminated
DSH340061CP	Child	DSH	UNC Hospitals	UNC Hospitals Imaging Center - Radiology-Diagnostic	430 Waterstone Drive	Hillsborough	NC	Active
DSH340061CQ	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus - Computed Tomography	430 Waterstone Drive	Hillsborough	NC	Active
DSH340061CR	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus - Cardiovascular Lab	430 Waterstone Drive	Hillsborough	NC	Terminated
DSH340061CS	Child	DSH	UNC Hospitals	UNC Hospitals Hillsborough Campus - Pulmonary Function Testing Lab	430 Waterstone Drive	Hillsborough	NC	Terminated
DSH340061CT	Child	DSH	UNC Hospitals	UNC Hospitals - Molecular Imaging at Mason Farm	125 Mason Farm Rd	Chapel Hill	NC	Terminated
DSH340061CU	Child	DSH	UNC Hospitals	UNC Cancer Care at Rockingham - Hematology/Oncology	516 South Van Buren Road	Eden	NC	Active
DSH340061CV	Child	DSH	UNC Hospitals	UNC Hospitals Urology Services Hillsborough - Urology	460 Waterstone Dr	Hillsborough	NC	Active
DSH340061CW	Child	DSH	UNC Hospitals	UNC HOSPITALS CHILDREN'S SPECIALTY - UNC Hospitals Children's Neurology Clinic in Chapel Hill at Carolina Pointe II	6011 FARRINGTON RD	CHAPEL HILL	NC	Active
DSH340061CX	Child	DSH	UNC Hospitals	UNC HOSPITALS CHILDREN'S SPECIALTY - Children's Specialty	6013 FARRINGTON RD	CHAPEL HILL	NC	Active
DSH340061CY	Child	DSH	UNC Hospitals	MCCREARY CANCER CENTER AT RIVERCRES - Oncology	160 RIVER BEND DR	GRANITE FALLS	NC	Active
DSH340061CZ	Child	DSH	UNC Hospitals	UNC HOSPITALS JASON RAY TRANSPLANT - UNCH JR Transplant Clinic ACC	102 MASON FARM RD	CHAPEL HILL	NC	Terminated
DSH340061D	Child	DSH	UNC Hospitals	UNC Hospitals Rheumatology at Eastowne	100 Eastowne Dr.	Chapel Hill	NC	Active
DSH340061DA	Child	DSH	UNC Hospitals	UNC HOSPITALS NEUROSURGERY - UNCH Neurosurgery Clinic at ACC	102 MASON FARM RD	CHAPEL HILL	NC	Active
DSH340061DB	Child	DSH	UNC Hospitals	UNC HOSPITALS VASCULAR SERVICES AT - UNC Hospitals Heart & Vascular Center at Meadowmont - Vascular & Wound Center	300 MEADOWMONT VILLAGE CIRCLE	CHAPEL HILL	NC	Active
DSH340061DC	Child	DSH	UNC Hospitals	UNIVERSITY OF NORTH CAROLINA HOSPIT - UNC Hospitals Urology at Eastowne	100 EASTOWNE DR	CHAPEL HILL	NC	Active
DSH340061DD	Child	DSH	UNC Hospitals	CARDIAC INVASIVE LAB - CARDIAC INVASIVE LAB	430 Waterstone Drive	Hillsborough	NC	Active
DSH340061DE	Child	DSH	UNC Hospitals	OPERATING ROOM HBO - OPERATING ROOM HBO	460 Waterstone Drive	Hillsborough	NC	Active
DSH340061F	Child	DSH	UNC Hospitals	UNC Hospitals Hand Rehabilitation Center	102 Mason Farm Road	Chapel Hill	NC	Terminated
DSH340061G	Child	DSH	UNC Hospitals	UNC Hospitals ACC Physical Therapy	102 Mason Farm Road	Chapel Hill	NC	Terminated
DSH340061J	Child	DSH	UNC Hospitals	Physical Therapy	100 Sprunt Street	Chapel Hill	NC	Terminated
DSH340061L	Child	DSH	UNC Hospitals	UNC Hospitals Pulmonology at Eastowne	100 Eastowne Dr.	Chapel Hill	NC	Active
DSH340061M	Child	DSH	UNC Hospitals	UNC Hospitals Children’s Specialty Services at Raleigh	2801 Blue Ridge Road	Raleigh	NC	Active
DSH340061P	Child	DSH	UNC Hospitals	UNC Hospitals – Family Medicine Center Laboratory	590 Manning Drive	Chapel Hill	NC	Terminated
DSH340061Q	Child	DSH	UNC Hospitals	UNC Hospitals Endocrinology at Eastowne	100 Eastowne Dr.	Chapel Hill	NC	Active
DSH340061R	Child	DSH	UNC Hospitals	UNC Hospitals Spine Center & Neurosurgery Clinic – Neurosurgery	1350 Raleigh Rd	Chapel Hill	NC	Terminated
DSH340061T	Child	DSH	UNC Hospitals	UNC Hospitals Imaging Center – Diagnostic X-ray	1350 Raleigh Rd	Chapel Hill	NC	Terminated
DSH340061V	Child	DSH	UNC Hospitals	UNC Hospitals Imaging Center – MRI	1350 Raleigh Rd	Chapel Hill	NC	Active
DSH340061W	Child	DSH	UNC Hospitals	UNC Hospitals Imaging Center – Mammography	1350 Raleigh Rd	Chapel Hill	NC	Terminated
DSH340061Y	Child	DSH	UNC Hospitals	UNC Hospitals Endoscopy Center at Meadowmont	300 Meadowmont Village Circle	Chapel Hill	NC	Active
DSH340061Z	Child	DSH	UNC Hospitals	UNC Hospitals Cardiology at Eastowne	100 Eastowne Dr.	Chapel Hill	NC	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Number	Update		3400061	3400061	12/10/2020 4:18 PM
Contacts	Authorizing Official	Update	AO Change Request	Ellington, Christopher CFO UNC Hospitals 9849744225	Daniels, Benjamin Rowell Chief Operating Officer UNC Hospitals 9849747744	4/8/2020 8:06 AM
Contacts	Authorizing Official	Update		Ellington, Christopher CFO 9849744225	Ellington, Christopher CFO UNC Hospitals 9849744225	10/19/2017 2:16 PM
Contacts	Authorizing Official	Update		Ellington, Christopher CFO 9199665111	Ellington, Christopher CFO 9849744225	9/11/2017 3:29 PM
Contacts	Authorizing Official	Insert			Ellington, Christopher CFO 9199665111	3/3/2017 10:02 AM
Contacts	Signed By	Insert			Ellington, Christopher CFO 9199665111	3/3/2017 10:02 AM
Contacts	Primary Contact	Insert			Lee, Sarah Pharmacy Clinical Manager 9849746652	10/21/2015 2:34 PM
Dates	Last Date That 340B Drugs Purchased	Update			6/19/2015 12:00:00 AM	7/29/2015 2:09 PM
Details	State	Update		Active	Terminated	7/29/2015 2:09 PM
Terminations	Termination Comments	Update			Site closed completely	7/29/2015 2:09 PM
Terminations	Termination Date	Update			10/1/2015 12:00:00 AM	7/29/2015 2:09 PM
Terminations	Termination Effective Date	Update			6/27/2015 12:00:00 AM	7/29/2015 2:09 PM
Terminations	Termination Reason	Update			Site closure	7/29/2015 2:09 PM
Addresses	Main Address	Insert			109 Conner Drive Chapel Hill, NC 27514	7/29/2015 2:09 PM
Addresses	Billing Address	Insert			UNC Hospitals 101 Manning Drive Chapel Hill, NC 27514	7/29/2015 2:09 PM
Addresses	Shipping Address	Insert			UNC Hospitals 101 Manning Drive Chapel Hill, NC 27514	7/29/2015 2:09 PM
Details	Last Recertification Date	Update			8/20/2014 12:00:00 AM	8/20/2014 2:06 PM
Dates	Participating Approval Date	Update			2/11/2014 12:00:00 AM	2/11/2014 5:54 AM
Details	State	Update		Pending	Active	2/11/2014 5:54 AM
Dates	Start Date	Update			4/1/2014 12:00:00 AM	2/11/2014 5:54 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH340061AT	2/4/2014 1:33 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/14/2014 9:01 PM
Medicaid Billing	Medicaid: Number	Insert			3400061	1/14/2014 9:01 PM
Medicaid Billing	Medicaid: State	Insert			NC	1/14/2014 9:01 PM
Medicaid Billing	NPI: Number	Insert			1932208576	1/14/2014 9:01 PM
Details	Last Recertification Date	Insert				1/14/2014 9:01 PM
Details	Grant Number	Insert				1/14/2014 9:01 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	1/14/2014 9:01 PM
Details	Is Authorizing Official EHB Data	Insert				1/14/2014 9:01 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/14/2014 9:01 PM
Details	Medicare Provider Number	Insert			340061	1/14/2014 9:01 PM
Details	Entity Name	Insert			UNC Hospitals	1/14/2014 9:01 PM
Details	Program Code	Insert			DSH	1/14/2014 9:01 PM
Details	Entity Subname	Insert			UNC Hospital Surgery Center at Conner Drive	1/14/2014 9:01 PM
Dates	Participating Approval Date	Insert				1/14/2014 9:01 PM
Details	State	Insert			Pending	1/14/2014 9:01 PM
Dates	Registration Date	Insert			1/14/2014 12:00:00 AM	1/14/2014 9:01 PM
Dates	Signed By Date	Insert			1/14/2014 12:00:00 AM	1/14/2014 9:01 PM
Dates	Start Date	Insert				1/14/2014 9:01 PM
Terminations	Termination Comments	Insert				1/14/2014 9:01 PM
Terminations	Termination Date	Insert				1/14/2014 9:01 PM
Terminations	Termination Effective Date	Insert				1/14/2014 9:01 PM
Terminations	Termination Reason	Insert				1/14/2014 9:01 PM