Covered Entity Details

DSH340053W Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center (Terminated) - information as of 6/8/2025 11:53:05 PM

Main Details

Name

Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center

Subdivision Name

Novant Health Charlotte Orthopedic Hospital Lithotripsy

Type

Disproportionate Share Hospital

Rural

340B ID

DSH340053W

Medicare Provider Number

340053

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/7/2015

Participating Start Date

10/1/2015

Participating Approval Date

7/15/2015

Last Recertification Date

8/31/2018

Termination Date
Termination Reason

10/1/2019
Site closure

Contacts

Authorizing Official

Novant Health
Geoffrey Gardner, SVP Finance
(336) 718-2078

Primary Contact

Novant Health
Elizabeth Anne Corazzo, Manager Pharmacy 340B
(336) 277-0301

Addresses

Street Address

1901 Randolph Road
Charlotte, NC 28207

Billing Address
Same as Street Address

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	3400053
CT	003037041 IP,008043573 OP
FL	92642600
IL	5605542300001
NJ	4171306
OH	0355244
PA	1007741400006
TN	340053
WI	81274300
SC	1881647204
VA	1881647204
		1881647204

Shipping Addresses

Shipping Address 1

Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center
200 Hawthorne Lane
Charlotte, NC 28204

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
DSH340053A	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Senior Care	6324 Fairview Road	Charlotte	NC	Terminated
DSH340053AA	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH HEART & VASCULAR INSTITUTE - MONROE	1640 E ROOSEVELT BLVD	MONROE	NC	Active
DSH340053AB	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH HEART & VASCULAR INSTITUTE - MATTHEWS	1401 MATTHEWS TOWNSHIP PKWY	MATTHEWS	NC	Active
DSH340053AC	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NOVANT HEALTH HEART & VASCULAR INSTITUTE - CHARLOTTE	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AD	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Cancer Institute - Ballantyne	10905 Providence Road West	Charlotte	NC	Active
DSH340053AE	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health PMC Outpatient Observation Beds - Novant Health COH Gastrointestinal 3SW	1901 Randolph Road	Charlotte	NC	Active
DSH340053AF	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health PMC Outpatient Observation Beds - Novant Health COH Med Surg 4SW	1901 Randolph Road	Charlotte	NC	Active
DSH340053AG	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Cancer Institute - University City	8401 UNIVERSITY EXEC PARK DR	CHARLOTTE	NC	Active
DSH340053AH	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Cancer Institute - Mooresville	170 MEDICAL PARK RD	MOORESVILLE	NC	Active
DSH340053AJ	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Presbyterian Medical Center Outpatient Infusion Mint Hill - Outpatient infusion	8201 Healthcare Loop	Charlotte	NC	Active
DSH340053AK	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NOVANT HEALTH CENTER CITY OUTPATIEN - Outpatient Surgery	1901 RANDOLPH RD	CHARLOTTE	NC	Active
DSH340053AL	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Cancer Institute - Huntersville	10030 GILEAD RD	HUNTERSVILLE	NC	Active
DSH340053AM	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health CI Outpatient Infusion Center Elizabeth (PMC)	125 Queens Road	CHARLOTTE	NC	Active
DSH340053AN	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH PMC Wound Care and Hyperbaric Medicine - Wound and Hyperbaric Medicine	300 Billingsly Rd	Charlotte	NC	ToBeTerminated
DSH340053AP	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH BH Outpatient Services Huntersville - Behavioral Health	13815 Professional Center Drive	Huntersville	NC	Active
DSH340053AQ	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INSTITUTE-HEMATOLOGY - HEMATOLOGY	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AR	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INSTITUTE-HEAD AND NECK - HEAD AND NECK ONCOLOGY	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AS	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INSTITUTE - THORACIC - THORACIC ONCOLOGY	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AT	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INSTITUTE PALLIATIVE CARE - PALLIATIVE CARE	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AU	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INST-GYN ONCOLOGY - GYNECOLOGIC ONCOLOGY	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AV	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INST-GASTROINTESTINAL - GI ONCOLOGY	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AW	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INTSTITUE - BREAST - BREAST SURGERY	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AX	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INSTITUTE - CELL THERAPY - HEMATOLOGY/ONCOLOGY	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AY	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INSTITUTE-GENITOURINARY - GENITOURINARY ONCOLOGY	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053AZ	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH CANCER INSTITUTE-INTEGRATED MED - INTEGRATIVE MEDICINE	125 QUEENS RD	CHARLOTTE	NC	Active
DSH340053B	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health McKee Internal Medicine	3330 Siskey Parkway	Matthews	NC	Terminated
DSH340053BA	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH Infusion South Park - Infusion	6324 Fairview Rd	Charlotte	NC	Active
DSH340053BB	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH Heart & Vascular - Cardiology	125 Queens Rd	Charlotte	NC	Active
DSH340053BC	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH Outpatient Hospice - Hospice	4105 Matthews Mint Hill Rd	Matthews	NC	Active
DSH340053BD	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH Rheumatology Arthritis South Park - Rheumatology Arthritis	6324 Fairview Rd	Charlotte	NC	Active
DSH340053BE	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NOVANT HEALTH MULTIPLE SCLEROSIS CA - Multiple Sclerosis	6324 FAIRVIEW RD	CHARLOTTE	NC	Active
DSH340053BF	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH Infusion - Ballantyne - Outpatient Infusion	14135 Ballantyne Corporate Plaza	Charlotte	NC	Active
DSH340053BG	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NH PMC Sleep Center - Sleep Study	1900 Randolph Rd	Charlotte	NC	Active
DSH340053BH	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Cancer Inst - Elizabeth Caner Risk & Genetics - Oncology	125 Queens Rd	Charlotte	NC	Active
DSH340053C	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Presbyterian Internal Medicine	1918 Randolph Road	Charlotte	NC	Terminated
DSH340053D	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Midtown Outpatient Surgery	1918 Randolph Road	Charlotte	NC	Active
DSH340053E	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Outpatient Surgery	1800 East 4th Street	Charlotte	NC	Active
DSH340053F	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Heart & Vascular Institute (Heart Failure Clinic)	1718 East 4th Street	Charlotte	NC	Terminated
DSH340053G	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Outpatient Infusion at Huntersville	10030 Gilead Road	Huntersville	NC	Active
DSH340053H	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Cancer Institute - Matthews	1700 Matthews Township Parkway	Matthews	NC	Active
DSH340053J	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	St. Jude Affiliate Clinic at Novant Health Hemby Children’s Hospital	301 Hawthorne Lane	Charlotte	NC	Active
DSH340053K	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital EKG	1901 Randolph Road	Charlotte	NC	Active
DSH340053L	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital Occupational Therapy	1901 Randolph Road	Charlotte	NC	Active
DSH340053M	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital Physical Therapy	1901 Randolph Road	Charlotte	NC	Active
DSH340053N	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital Respiratory Therapy	1901 Randolph Road	Charlotte	NC	Active
DSH340053P	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital MRI	1901 Randolph Road	Charlotte	NC	Active
DSH340053Q	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital CT Scan	1901 Randolph Road	Charlotte	NC	Active
DSH340053R	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital Radiology -Diagnostics	1901 Randolph Road	Charlotte	NC	Active
DSH340053S	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital Anesthesiology	1901 Randolph Road	Charlotte	NC	Active
DSH340053T	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital Operating Room	1901 Randolph Road	Charlotte	NC	Active
DSH340053U	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Outpatient Infusion at Matthews	1500 Matthews Township Pkwy	Matthews	NC	Active
DSH340053V	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital Pain Management Center	1901 Randolph Road	Charlotte	NC	Terminated
DSH340053W	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital Lithotripsy	1901 Randolph Road	Charlotte	NC	Terminated
DSH340053X	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopedic Hospital Total Joint Unit Observation Beds	1901 Randolph Road	Charlotte	NC	Terminated
DSH340053Y	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	Novant Health Charlotte Orthopaedic Hospital Orthopaedic Spine Unit - Observation Beds	1901 Randolph Road	Charlotte	NC	Active
DSH340053Z	Child	DSH	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	NOVANT HEALTH HEART & VASCULAR INSTITUTE - HUNTERSVILLE	10030 GILEAD ROAD	HUNTERSVILLE	NC	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Hansen, Elizabeth Corazzo Supervisor Pharmacy 340B Novant Health 3362770301	Corazzo, Elizabeth Anne Manager Pharmacy 340B Novant Health 3362770301	2/7/2023 4:18 PM
Contacts	Authorizing Official	Update	Change Request	Terrell, Cedric A SVP Pharmacy Services Novant Health, Inc. 7043840611	Gardner, Geoffrey SVP Finance Novant Health 3367182078	1/28/2020 3:56 PM
Details	State	Update		To Be Terminated	Terminated	10/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		5/1/2019 12:00:00 AM	7/16/2019 6:39 AM
Details	State	Update	Termination Request	Active	To Be Terminated	7/16/2019 6:39 AM
Terminations	Termination Date	Update	Termination Request		10/1/2019 12:00:00 AM	7/16/2019 6:39 AM
Terminations	Termination Effective Date	Update	Termination Request		5/31/2019 12:00:00 AM	7/16/2019 6:39 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	7/16/2019 6:39 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1881647204	11/6/2018 3:16 PM
Details	Last Recertification Date	Update	Recertification	11/15/2017 10:19:07 PM	8/31/2018 4:12:10 PM	8/31/2018 4:12 PM
Contacts	Authorizing Official	Update	Change Request	Vincent, Paula President and COO, Presbyterian Medical Center Novant Health Presbyterian Medical Center 7043849656	Terrell, Cedric A SVP Pharmacy Services Novant Health, Inc. 7043840611	7/5/2018 2:52 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/3/2018 5:20 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1881647204	4/3/2018 5:20 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	4/3/2018 5:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/3/2018 5:20 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1881647204	4/3/2018 5:20 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		VA	4/3/2018 5:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003037041 IP	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		008043573 OP	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		92642600	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		5605542300001	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		4171306	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NJ	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0355244	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007741400006	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		340053	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		81274300	4/2/2018 2:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WI	4/2/2018 2:39 PM
Details	Entity Name	Update	Recertification	PRESBYTERIAN HOSPITAL	Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center	11/15/2017 10:20 PM
Addresses	Shipping Address	Insert	Recertification		Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center 200 Hawthorne Lane Charlotte, NC 28204	11/15/2017 10:19 PM
Details	Last Recertification Date	Update	Recertification	8/31/2016 12:00:00 AM	11/15/2017 10:19:07 PM	11/15/2017 10:19 PM
Contacts	Primary Contact	Update	Recertification	Hansen, Elizabeth Supervisor Pharmacy 340B Novant Health 3362770301	Hansen, Elizabeth Corazzo Supervisor Pharmacy 340B Novant Health 3362770301	11/6/2017 10:31 AM
Contacts	Authorizing Official	Update		Vincent, Paula President and COO, Presbyterian Medical Center 7043849656	Vincent, Paula President and COO, Presbyterian Medical Center Novant Health Presbyterian Medical Center 7043849656	10/16/2017 11:01 AM
Contacts	Primary Contact	Update		Hansen, Elizabeth Supervisor Pharmacy 340B 3362770301	Hansen, Elizabeth Supervisor Pharmacy 340B Novant Health 3362770301	9/27/2017 2:34 PM
Contacts	Primary Contact	Update		Hissam, Jennifer Director of Pharmacy 7043845263	Hansen, Elizabeth Supervisor Pharmacy 340B 3362770301	8/3/2017 3:00 PM
Contacts	Signed By	Insert			Vaccaro, Michael Chief Nursing Officer, Novant Health Greater Charlotte Market 7043845111	7/28/2017 6:12 PM
Contacts	Authorizing Official	Insert			Vincent, Paula President and COO, Presbyterian Medical Center 7043849656	7/28/2017 6:12 PM
Addresses	Main Address	Insert			1901 Randolph Road Charlotte, NC 28207	7/28/2017 6:12 PM
Contacts	Primary Contact	Insert			Hissam, Jennifer Director of Pharmacy 7043845263	2/7/2017 10:22 AM
Details	Last Recertification Date	Update			8/31/2016 12:00:00 AM	8/31/2016 3:55 PM
Dates	Participating Approval Date	Update			7/15/2015 12:00:00 AM	7/15/2015 3:17 PM
Details	State	Update		Pending	Active	7/15/2015 3:17 PM
Dates	Start Date	Update			10/1/2015 12:00:00 AM	7/15/2015 3:17 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_52437	DSH340053W	7/10/2015 5:43 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_52437	7/7/2015 4:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/7/2015 4:25 PM
Medicaid Billing	Medicaid: Number	Insert			3400053	7/7/2015 4:25 PM
Medicaid Billing	Medicaid: State	Insert			NC	7/7/2015 4:25 PM
Details	Last Recertification Date	Insert				7/7/2015 4:25 PM
Details	Grant Number	Insert				7/7/2015 4:25 PM
Details	340B ID	Insert				7/7/2015 4:25 PM
Details	Is Authorizing Official EHB Data	Insert				7/7/2015 4:25 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/7/2015 4:25 PM
Details	Medicare Provider Number	Insert			340053	7/7/2015 4:25 PM
Details	Entity Name	Insert			PRESBYTERIAN HOSPITAL	7/7/2015 4:25 PM
Details	Program Code	Insert			DSH	7/7/2015 4:25 PM
Details	Entity Subname	Insert			Novant Health Charlotte Orthopedic Hospital Lithotripsy	7/7/2015 4:25 PM
Dates	Participating Approval Date	Insert				7/7/2015 4:25 PM
Details	State	Insert			Pending	7/7/2015 4:25 PM
Dates	Registration Date	Insert			7/7/2015 12:00:00 AM	7/7/2015 4:25 PM
Dates	Signed By Date	Insert			7/7/2015 12:00:00 AM	7/7/2015 4:25 PM
Dates	Start Date	Insert				7/7/2015 4:25 PM
Terminations	Termination Comments	Insert				7/7/2015 4:25 PM
Terminations	Termination Date	Insert				7/7/2015 4:25 PM
Terminations	Termination Effective Date	Insert				7/7/2015 4:25 PM
Terminations	Termination Reason	Insert				7/7/2015 4:25 PM