Covered Entity Details

DSH340061BG UNC Hospitals (Terminated) - information as of 4/25/2025 12:01:03 AM

Main Details

Name

UNC Hospitals

Subdivision Name

UNC Hospitals Heart & Vascular Center at Meadowmont - Vascular & Wound Center

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH340061BG

Medicare Provider Number

340061

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/15/2015

Participating Start Date

4/1/2015

Participating Approval Date

3/10/2015

Last Recertification Date

8/31/2023

Termination Date
Termination Reason

10/1/2024
Business decision by the Covered Entity

Contacts

Authorizing Official

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

Primary Contact

UNC Health
Jordan Rush, Director of 340B Programs
(984) 215-5892

Addresses

Street Address

300 Meadowmont Village Circle
Suite 301
Chapel Hill, NC 27517

Billing Address

UNC Hospitals Pharmacy
4400 Emperor Blvd
Suite 100
Durham, NC 27703

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	340061	1932208576
SC	414097	1932208576
VA	9817026	1932208576

Shipping Addresses

Shipping Address 1

UNC Hospitals
101 Manning Drive
Chapel Hill, NC 27514

Shipping Address 2

UNC Shared Services Center Pharmacy
4400 Emperor Blvd
Suite 100
Durham, NC 27703

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
Details	State	Update		To Be Terminated	Terminated	10/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		10/1/2024 12:00:00 AM	7/12/2024 8:12 AM
Details	State	Update	Termination Request	Active	To Be Terminated	7/12/2024 8:12 AM
Terminations	Termination Date	Update	Termination Request		10/1/2024 12:00:00 AM	7/12/2024 8:12 AM
Terminations	Termination Effective Date	Update	Termination Request		10/1/2024 12:00:00 AM	7/12/2024 8:12 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	7/12/2024 8:12 AM
Contacts	Primary Contact	Update	Profile Change Request	Rush, Jordan Director of 340B Programs UNC Health 3369914551	Rush, Jordan Director of 340B Programs UNC Health 9842155892	12/18/2023 11:42 AM
Details	Last Recertification Date	Update	Recertification	9/17/2022 2:28:40 PM	8/31/2023 9:56:43 AM	8/31/2023 9:56 AM
Contacts	Primary Contact	Update	Group Change Request	Tran, Roya 340B Pharmacist Coordinator UNC Hospitals 9849745661	Rush, Jordan Director of 340B Programs UNC Health 3369914551	5/31/2023 9:32 AM
Details	Last Recertification Date	Update	Recertification	9/3/2021 7:11:40 AM	9/17/2022 2:28:40 PM	9/17/2022 2:28 PM
Details	Last Recertification Date	Update	Recertification	9/11/2020 11:09:46 AM	9/3/2021 7:11:40 AM	9/3/2021 7:11 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1746894 (LA)		8/12/2021 11:19 AM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1932208576 (LA)		8/12/2021 11:19 AM
Contacts	Primary Contact	Update	Group Change Request	McAllister, Anita Groves Director Pharmacy 340B Program Management UNC Hospitals 9842156625	Tran, Roya 340B Pharmacist Coordinator UNC Hospitals 9849745661	8/12/2021 11:19 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	2011697 (WA)		1/13/2021 10:26 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1932208576 (WA)		1/13/2021 10:26 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	090657300 (FL)		10/9/2020 9:45 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1932208576 (FL)		10/9/2020 9:45 AM
Contacts	Primary Contact	Update	Recertification	Tran, Roya 340B Pharmacist Coordinator UNC Hospitals 9849745661	McAllister, Anita Groves Director Pharmacy 340B Program Management UNC Hospitals 9842156625	9/11/2020 11:09 AM
Details	Last Recertification Date	Update	Recertification	8/19/2019 8:34:24 AM	9/11/2020 11:09:46 AM	9/11/2020 11:09 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1932208576	8/10/2020 10:20 PM
Medicaid Billing	NPI: State	Insert	Change Request		FL	8/10/2020 10:20 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1932208576	8/10/2020 10:20 PM
Medicaid Billing	NPI: State	Insert	Change Request		LA	8/10/2020 10:20 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1932208576	8/10/2020 10:20 PM
Medicaid Billing	NPI: State	Insert	Change Request		SC	8/10/2020 10:20 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1932208576	8/10/2020 10:20 PM
Medicaid Billing	NPI: State	Insert	Change Request		VA	8/10/2020 10:20 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1932208576	8/10/2020 10:20 PM
Medicaid Billing	NPI: State	Insert	Change Request		WA	8/10/2020 10:20 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1932208576	8/10/2020 10:20 PM
Medicaid Billing	NPI: State	Insert	Change Request		NC	8/10/2020 10:20 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1932208576 ( )		8/10/2020 10:20 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1538450242 ( )		8/10/2020 10:20 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1053334912 ( )		6/16/2020 8:30 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1205840857 ( )		6/16/2020 8:30 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1669808564 ( )		6/16/2020 8:30 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1831576982 ( )		6/16/2020 8:30 AM
Contacts	Primary Contact	Update	Change Request	Mann, Jami Clinical Manager, Administrative Services UNC Hospitals 9849740085	Tran, Roya 340B Pharmacist Coordinator UNC Hospitals 9849745661	6/16/2020 8:30 AM
Addresses	Shipping Address	Delete	Change Request	UNC Shared Services Center Pharmacy 4400 Emperor Blvd Durham, NC 27703		5/18/2020 8:18 AM
Addresses	Shipping Address	Insert	Change Request		UNC Shared Services Center Pharmacy 4400 Emperor Blvd Suite 100 Durham, NC 27703	5/18/2020 8:18 AM
Addresses	Billing Address	Update	Change Request	UNC Hospitals Pharmacy 4400 Emperor Blvd Durham, NC 27703	UNC Hospitals Pharmacy 4400 Emperor Blvd Suite 100 Durham, NC 27703	5/18/2020 8:18 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/18/2020 8:18 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		340061	5/18/2020 8:18 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	5/18/2020 8:18 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	000155625X (GA)		5/18/2020 8:18 AM
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
Details	Last Recertification Date	Update	Recertification	8/20/2018 7:46:58 AM	8/19/2019 8:34:24 AM	8/19/2019 8:34 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	411925800 (MD)		8/7/2019 7:08 AM
Details	Entity Subname	Update	Change Request	UNC Hospitals Heart & Vascular Center at Meadowmont	UNC Hospitals Heart & Vascular Center at Meadowmont - Vascular & Wound Center	1/8/2019 8:44 AM
Details	Last Recertification Date	Update	Recertification	11/6/2017 7:40:20 AM	8/20/2018 7:46:58 AM	8/20/2018 7:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		090657300	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		000155625X	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1746894	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		411925800	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		414097	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		9817026	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		VA	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		2011697	7/16/2018 8:30 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	7/16/2018 8:30 AM
Contacts	Primary Contact	Update	Change Request	Williams, Alexandra 340B Program Coordinator UNC Hospitals 9849746678	Mann, Jami Clinical Manager, Administrative Services UNC Hospitals 9849740085	3/13/2018 10:01 AM
Details	Last Recertification Date	Update	Recertification	8/16/2016 12:00:00 AM	11/6/2017 7:40:20 AM	11/6/2017 7:40 AM
Contacts	Authorizing Official	Update		Ellington, Christopher CFO 9849744225	Ellington, Christopher CFO UNC Hospitals 9849744225	10/19/2017 2:16 PM
Contacts	Signed By	Update		Ellington, Christopher CFO 9849744225	Ellington, Christopher CFO UNC Hospitals 9849744225	10/19/2017 2:16 PM
Contacts	Primary Contact	Update		Williams, Alexandra 340B Program Coordinator 9849746678	Williams, Alexandra 340B Program Coordinator UNC Hospitals 9849746678	10/1/2017 6:23 PM
Contacts	Authorizing Official	Insert			Ellington, Christopher CFO 9849744225	8/14/2017 9:05 PM
Contacts	Signed By	Insert			Ellington, Christopher CFO 9849744225	8/14/2017 9:05 PM
Contacts	Primary Contact	Insert			Williams, Alexandra 340B Program Coordinator 9849746678	8/14/2017 9:05 PM
Addresses	Main Address	Insert			300 Meadowmont Village Circle Suite 301 Chapel Hill, NC 27517	3/3/2017 10:02 AM
Addresses	Billing Address	Insert			UNC Hospitals Pharmacy 4400 Emperor Blvd Durham, NC 27703	3/3/2017 10:02 AM
Addresses	Shipping Address	Insert			UNC Hospitals 101 Manning Drive Chapel Hill, NC 27514	3/3/2017 10:02 AM
Addresses	Shipping Address	Insert			UNC Shared Services Center Pharmacy 4400 Emperor Blvd Durham, NC 27703	3/3/2017 10:02 AM
Medicaid Billing	NPI: Number	Insert			1669808564	2/15/2017 9:01 PM
Medicaid Billing	NPI: Number	Insert			1831576982	2/15/2017 9:01 PM
Details	Last Recertification Date	Update		8/19/2015 12:00:00 AM	8/16/2016 12:00:00 AM	8/16/2016 8:48 AM
Details	Entity Subname	Update		Endovascular Clinic-Heart & Vascular at Meadowmont	UNC Hospitals Heart & Vascular Center at Meadowmont	8/16/2016 8:48 AM
Medicaid Billing	NPI: Number	Insert			1053334912	5/18/2016 11:58 AM
Medicaid Billing	NPI: Number	Insert			1205840857	5/18/2016 11:58 AM
Medicaid Billing	NPI: Number	Insert			1538450242	5/18/2016 11:58 AM
Details	Entity Name	Update		UNIVERSITY OF NORTH CAROLINA HOSP.	UNC Hospitals	5/18/2016 11:58 AM
Details	Last Recertification Date	Update			8/19/2015 12:00:00 AM	8/19/2015 7:49 PM
Dates	Participating Approval Date	Update			3/10/2015 12:00:00 AM	3/10/2015 4:41 PM
Details	State	Update		Pending	Active	3/10/2015 4:41 PM
Dates	Start Date	Update			4/1/2015 12:00:00 AM	3/10/2015 4:41 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_49592	DSH340061BG	2/4/2015 11:02 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_49592	1/15/2015 12:38 AM
Medicaid Billing	NPI: Number	Insert			1932208576	1/15/2015 12:38 AM
Details	Last Recertification Date	Insert				1/15/2015 12:38 AM
Details	Grant Number	Insert				1/15/2015 12:38 AM
Details	340B ID	Insert				1/15/2015 12:38 AM
Details	Is Authorizing Official EHB Data	Insert				1/15/2015 12:38 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/15/2015 12:38 AM
Details	Medicare Provider Number	Insert			340061	1/15/2015 12:38 AM
Details	Entity Name	Insert			UNIVERSITY OF NORTH CAROLINA HOSP.	1/15/2015 12:38 AM
Details	Program Code	Insert			DSH	1/15/2015 12:38 AM
Details	Entity Subname	Insert			Endovascular Clinic-Heart & Vascular at Meadowmont	1/15/2015 12:38 AM
Dates	Participating Approval Date	Insert				1/15/2015 12:38 AM
Details	State	Insert			Pending	1/15/2015 12:38 AM
Dates	Registration Date	Insert			1/15/2015 12:00:00 AM	1/15/2015 12:38 AM
Dates	Signed By Date	Insert			1/15/2015 12:00:00 AM	1/15/2015 12:38 AM
Dates	Start Date	Insert				1/15/2015 12:38 AM
Terminations	Termination Comments	Insert				1/15/2015 12:38 AM
Terminations	Termination Date	Insert				1/15/2015 12:38 AM
Terminations	Termination Effective Date	Insert				1/15/2015 12:38 AM
Terminations	Termination Reason	Insert				1/15/2015 12:38 AM