Covered Entity Details

DSH340002AZ MISSION HOSPITALS, INC. (Terminated) - information as of 6/2/2025 8:32:54 AM

Main Details

Name

MISSION HOSPITALS, INC.

Subdivision Name

Outpatient Care Center - Clyde / Asheville Orthopedic Associates - Clyde

Type

Disproportionate Share Hospital

Rural

340B ID

DSH340002AZ

Medicare Provider Number

340002

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/17/2017

Participating Start Date

7/1/2017

Participating Approval Date

5/1/2017

Last Recertification Date

9/4/2018

Termination Date
Termination Reason

4/1/2019
For-Profit conversion

Contacts

Authorizing Official

Mission Health System
Paul L McDowell, CFO
(828) 213-0184

Primary Contact

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

Addresses

Street Address

360 Hospital Drive
Clyde, NC 28721

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	34-00002
GA	000146715Z
TN	0340002
SC	213986,191902
		1881626075

Shipping Addresses

Same as Street Address

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
DSH340002A	Child	DSH	MISSION HOSPITALS, INC.	ASHEVILLE SURGERY CENTER	5 MEDICAL PARK DRIVE	ASHEVILLE	NC	Terminated
DSH340002AA	Child	DSH	MISSION HOSPITALS, INC.	Mission Interventional Spine - Radiology	7 Vanderbilt Park	Asheville	NC	Terminated
DSH340002AB	Child	DSH	MISSION HOSPITALS, INC.	Mission Outpatient Infusion at Hope	100 Ridgefield Court	ASHEVILLE	NC	Terminated
DSH340002AC	Child	DSH	MISSION HOSPITAL INC.	Heart Failure Clinic	5 Vanderbilt Park Drive	Asheville	NC	Terminated
DSH340002AD	Child	DSH	MISSION HOSPITALS, INC.	St. Joseph Hospital / OR Services	428 Biltmore Avenue	Asheville	NC	Terminated
DSH340002AE	Child	DSH	MISSION HOSPITALS, INC.	St. Joseph Hospital / Laboratory Services	428 Biltmore Avenue	Asheville	NC	Terminated
DSH340002AF	Child	DSH	MISSION HOSPITALS, INC.	St. Joseph Hospital / Respiratory Services	428 Biltmore Avenue	Asheville	NC	Terminated
DSH340002AG	Child	DSH	MISSION HOSPITAL INC.	St. Joseph Hospital / Clinic Services	428 Biltmore Avenue	Asheville	NC	Terminated
DSH340002AH	Child	DSH	MISSION HOSPITAL INC.	St. Joseph Hospital / Sub-Provider I	428 Biltmore Avenue	Asheville	NC	Terminated
DSH340002AJ	Child	DSH	MISSION HOSPITALS, INC.	Radiology at Mission My Care Plus Biltmore Park	310 Long Shoals Road	Asheville	NC	Terminated
DSH340002AK	Child	DSH	MISSION HOSPITALS, INC.	St. Joseph Hospital / SJ 5th Floor & 6 North - Pulmonary - Observation	428 Biltmore Avenue	Asheville	NC	Terminated
DSH340002AL	Child	DSH	MISSION HOSPITALS, INC.	St. Joseph Hospital / 7th & 8th Floors & Ortho 6J - Observation	428 Biltmore Avenue	Asheville	NC	Terminated
DSH340002AM	Child	DSH	MISSION HOSPITALS, INC.	St. Joseph Hospital / Critical Care & Stepdown- Observation	428 Biltmore Avenue	Asheville	NC	Terminated
DSH340002AN	Child	DSH	MISSION HOSPITALS, INC.	Radiology Services at Hope Cancer Center	100 Ridgefield Court	Asheville	NC	Terminated
DSH340002AP	Child	DSH	MISSION HOSPITALS, INC.	Cancer Center Radiology Services	21 Hospital Drive	Asheville	NC	Terminated
DSH340002AQ	Child	DSH	MISSION HOSPITALS, INC.	Mission Behavioral Health, Psych Day Program	1 Hospital Drive	Asheville	NC	Terminated
DSH340002AR	Child	DSH	MISSION HOSPITALS, INC.	Reuters Children's Services / Pediatric Endocrinology	11 Vanderbilt Park Drive	Asheville	NC	Terminated
DSH340002AS	Child	DSH	MISSION HOSPITALS, INC.	Mission Children's Clinics / Radiology Services at Reuters	11 Vanderbilt Park	Asheville	NC	Terminated
DSH340002AT	Child	DSH	MISSION HOSPITALS, INC.	Mission Radiology at Sand Hill Road	1388 Sand Hill Road	Candler	NC	Terminated
DSH340002AU	Child	DSH	MISSION HOSPITALS, INC.	Pediatric Comm Transition	11 Vanderbilt Park	Asheville	NC	Terminated
DSH340002AV	Child	DSH	MISSION HOSPITALS, INC.	Hope Cancer Center / PSA	100 Ridgefield Court	Asheville	NC	Terminated
DSH340002AW	Child	DSH	MISSION HOSPITALS, INC.	CCWNC - Cancer Center	21 Hospital Drive, 4th Floor	Asheville	NC	Terminated
DSH340002AX	Child	DSH	MISSION HOSPITALS, INC.	Outpatient Care Center - Clyde / Carolina Spine (CSNC)	360 Hospital Drive	Clyde	NC	Terminated
DSH340002AY	Child	DSH	MISSION HOSPITALS, INC.	Mountain Radiation Oncology	21 Hospital Drive, Lower Level	Asheville	NC	Terminated
DSH340002AZ	Child	DSH	MISSION HOSPITALS, INC.	Outpatient Care Center - Clyde / Asheville Orthopedic Associates - Clyde	360 Hospital Drive	Clyde	NC	Terminated
DSH340002B	Child	DSH	MISSION HOSPITALS, INC.	ST JOSEPHS HOSPITAL	428 BILTMORE AVE	ASHEVILLE	NC	Terminated
DSH340002BA	Child	DSH	MISSION HOSPITALS, INC.	Disease Management	1 Hospital Drive, 3rd Floor	Asheville	NC	Terminated
DSH340002BB	Child	DSH	MISSION HOSPITALS, INC.	Reuters Children's Services / Pediatric Orthopedics	11 Vanderbilt Park Drive	Asheville	NC	Terminated
DSH340002BC	Child	DSH	MISSION HOSPITALS, INC.	Orthopedic Radiology	1 Hospital Drive, 4th Floor	Asheville	NC	Terminated
DSH340002BD	Child	DSH	MISSION HOSPITALS, INC.	Carolina Vascular PSA - 222 Asheland / Ultrasound	222 Asheland	Asheville	NC	Terminated
DSH340002BE	Child	DSH	MISSION HOSPITALS, INC.	222 Asheland Procedure / Carolina Vascular PSA	222 Asheland Avenue	Asheville	NC	Terminated
DSH340002BF	Child	DSH	MISSION HOSPITALS, INC.	Interventional Spine - PSA (WSP)	7 Vanderbilt Park Road	Asheville	NC	Terminated
DSH340002BG	Child	DSH	MISSION HOSPITALS, INC.	Mission CV Diagnostics - Hendersonville	691 Blythe Street	Hendersonville	NC	Terminated
DSH340002BH	Child	DSH	MISSION HOSPITALS, INC.	Mission Breast Center / Mammography	534 Biltmore Avenue	Asheville	NC	Terminated
DSH340002BJ	Child	DSH	MISSION HOSPITALS, INC.	Mission Sleep Center	5 Vanderbilt Park Drive	Asheville	NC	Terminated
DSH340002BK	Child	DSH	MISSION HOSPITALS, INC.	Mission Cancer Center / Multi-Disciplinary Clinic	21 Hospital Drive, 2nd Floor	Asheville	NC	Terminated
DSH340002BL	Child	DSH	MISSION HOSPITALS, INC.	Mammography - 2 Town Square	2 Town Square Blvd., Suite 110	Asheville	NC	Terminated
DSH340002BM	Child	DSH	MISSION HOSPITALS, INC.	Reuters Children's Services / Pediatric Comm Transition	11 Vanderbilt Park Drive	Asheville	NC	Terminated
DSH340002BN	Child	DSH	MISSION HOSPITALS, INC.	Reuters Children's Services / Pediatric Surgery	11 Vanderbilt Park Drive	Asheville	NC	Terminated
DSH340002BP	Child	DSH	MISSION HOSPITALS, INC.	Reuters Children's Services / Pediatric Pulmonology	11 Vanderbilt Park Drive	Asheville	NC	Terminated
DSH340002BQ	Child	DSH	MISSION HOSPITALS, INC.	Mission Hospital / - PACE Program	286 Overlook Road	Asheville	NC	Terminated
DSH340002C	Child	DSH	MISSION HOSPITALS, INC.	Mission Cancer/Infusion Services	21 Hospital Dr., Third Floor	ASHEVILLE	NC	Terminated
DSH340002F	Child	DSH	MISSION HOSPITALS, INC.	MISSION REUTER CHILDREN'S OUTPATIENT CENTER	11 VANDERBILT PARK	ASHEVILLE	NC	Terminated
DSH340002G	Child	DSH	MISSION HOSPITALS, INC.	Mission Health Path and ICR	5 Vanderbilt Park Dr	Asheville	NC	Terminated
DSH340002J	Child	DSH	MISSION HOSPITALS, INC.	Mission Cardiovascular Diagnostics	5 Vanderbilt Park Dr.	Asheville	NC	Terminated
DSH340002K	Child	DSH	MISSION HOSPITALS, INC.	Health Education & Chronic Condition Clinic	1 Hospital Drive, Suites 2201, 3200, 3219 & 3220	Asheville	NC	Terminated
DSH340002L	Child	DSH	MISSION HOSPITALS, INC.	Mission Outpatient Care Center	360 Hospital Dr.	Clyde	NC	Terminated
DSH340002M	Child	DSH	MISSION HOSPITALS, INC.	Outpatient Rehab	534 Biltmore Ave	Asheville	NC	Terminated
DSH340002N	Child	DSH	MISSION HOSPITALS, INC.	Mission Sports Medicine	534 Biltmore Ave	Asheville	NC	Terminated
DSH340002P	Child	DSH	MISSION HOSPITALS, INC.	Mission Rehab Low Vision Center	240 Sardis Rd.	Asheville	NC	Terminated
DSH340002Q	Child	DSH	MISSION HOSPITALS, INC.	Mission Wound Therapy Center	1 Hospital Drive, Suite 4100	Asheville	NC	Terminated
DSH340002R	Child	DSH	MISSION HOSPITALS, INC.	Mission OP Clinical Pharmacy Services	1 Hospital Drive, Suites 3296	Asheville	NC	Terminated
DSH340002T	Child	DSH	MISSION HOSPITALS, INC.	Mission Radiology at Victoria Urological Associates	100 Victoria Rd.	Asheville	NC	Terminated
DSH340002U	Child	DSH	MISSION HOSPITALS, INC.	Mission Olsen Huff Center Practice	11 Vanderbilt Park Drive	Asheville	NC	Terminated
DSH340002V	Child	DSH	MISSION HOSPITALS, INC.	Mission Children's Clinics, Procedure Suite	11 Vanderbilt Park Drive, Suite 2500	Asheville	NC	Terminated
DSH340002W	Child	DSH	MISSION HOSPITALS, INC.	Mission Child Medical Evaluation	11 Vanderbilt Park Drive	Asheville	NC	Terminated
DSH340002X	Child	DSH	MISSION HOSPITALS, INC.	Mission Childrens Clinics, Genetics Center	11 Vanderbilt Park Drive, Suite 1500	Asheville	NC	Terminated
DSH340002Y	Child	DSH	MISSION HOSPITALS, INC.	Mission Pediatric Hematology / Oncology	21 Hospital Drive, 2nd Floor	Asheville	NC	Terminated
DSH340002Z	Child	DSH	MISSION HOSPITALS, INC.	Wound Healing Center	360 Hospital Drive	Clyde	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 10:20 AM
Details	State	Update	Termination Request	Active	To Be Terminated	1/30/2019 10:20 AM
Terminations	Termination Comments	Update	Termination Request		Hospital will become a for-profit entity on 2/1/2019 due to acquisition by HCA.	1/30/2019 10:20 AM
Terminations	Termination Date	Update	Termination Request		4/1/2019 12:00:00 AM	1/30/2019 10:20 AM
Terminations	Termination Effective Date	Update	Termination Request		2/1/2019 12:00:00 AM	1/30/2019 10:20 AM
Terminations	Termination Reason	Update	Termination Request		For-Profit conversion	1/30/2019 10:20 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1881626075	9/4/2018 12:37 PM
Details	Last Recertification Date	Update	Recertification	11/3/2017 12:36:02 PM	9/4/2018 12:37:23 PM	9/4/2018 12:37 PM
Details	Last Recertification Date	Update	Recertification	10/24/2017 6:40:55 PM	11/3/2017 12:36:02 PM	11/3/2017 12:36 PM
Details	Entity Name	Update	Recertification	MISSION HOSPITAL INC	MISSION HOSPITALS, INC.	10/25/2017 10:20 AM
Details	Last Recertification Date	Update	Recertification		10/24/2017 6:40:55 PM	10/24/2017 6:40 PM
Contacts	Authorizing Official	Update		McDowell, Paul CFO 8282130184	McDowell, Paul L CFO Mission Health System 8282130184	10/9/2017 9:20 AM
Contacts	Signed By	Update		McDowell, Paul CFO 8282130184	McDowell, Paul L CFO Mission Health System 8282130184	10/9/2017 9:20 AM
Contacts	Primary Contact	Update	Profile Change Request	Knudsen, Alan K. Pharmacy Specialist, 340B Program Mission Health 8288134213	Knudsen, Alan K. Pharmacy Specialist, 340B Program Mission Health 8282134213	9/27/2017 4:21 PM
Contacts	Primary Contact	Update		Knudsen, Alan K. Pharmacy Specialist, 340B Program 8288134213	Knudsen, Alan K. Pharmacy Specialist, 340B Program Mission Health 8288134213	9/18/2017 4:44 PM
Contacts	Authorizing Official	Insert			McDowell, Paul CFO 8282130184	8/1/2017 9:19 AM
Contacts	Signed By	Insert			McDowell, Paul CFO 8282130184	8/1/2017 9:19 AM
Contacts	Primary Contact	Insert			Knudsen, Alan K. Pharmacy Specialist, 340B Program 8288134213	8/1/2017 9:19 AM
Addresses	Main Address	Insert			360 Hospital Drive Clyde, NC 28721	7/26/2017 3:58 PM
Dates	Participating Approval Date	Update			5/1/2017 12:00:00 AM	5/1/2017 2:26 PM
Details	State	Update		Pending	Active	5/1/2017 2:26 PM
Dates	Start Date	Update			7/1/2017 12:00:00 AM	5/1/2017 2:26 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_77230	DSH340002AZ	4/25/2017 1:38 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_77230	4/17/2017 10:28 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/17/2017 10:28 AM
Medicaid Billing	Medicaid: Number	Insert			34-00002	4/17/2017 10:28 AM
Medicaid Billing	Medicaid: State	Insert			NC	4/17/2017 10:28 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/17/2017 10:28 AM
Medicaid Billing	Medicaid: Number	Insert			000146715Z	4/17/2017 10:28 AM
Medicaid Billing	Medicaid: State	Insert			GA	4/17/2017 10:28 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/17/2017 10:28 AM
Medicaid Billing	Medicaid: Number	Insert			0340002	4/17/2017 10:28 AM
Medicaid Billing	Medicaid: State	Insert			TN	4/17/2017 10:28 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/17/2017 10:28 AM
Medicaid Billing	Medicaid: Number	Insert			213986	4/17/2017 10:28 AM
Medicaid Billing	Medicaid: State	Insert			SC	4/17/2017 10:28 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/17/2017 10:28 AM
Medicaid Billing	Medicaid: Number	Insert			191902	4/17/2017 10:28 AM
Medicaid Billing	Medicaid: State	Insert			SC	4/17/2017 10:28 AM
Details	Last Recertification Date	Insert				4/17/2017 10:28 AM
Details	Grant Number	Insert				4/17/2017 10:28 AM
Details	340B ID	Insert				4/17/2017 10:28 AM
Details	Is Authorizing Official EHB Data	Insert				4/17/2017 10:28 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/17/2017 10:28 AM
Details	Medicare Provider Number	Insert			340002	4/17/2017 10:28 AM
Details	Entity Name	Insert			MISSION HOSPITAL INC	4/17/2017 10:28 AM
Details	Program Code	Insert			DSH	4/17/2017 10:28 AM
Details	Entity Subname	Insert			Outpatient Care Center - Clyde / Asheville Orthopedic Associates - Clyde	4/17/2017 10:28 AM
Dates	Participating Approval Date	Insert				4/17/2017 10:28 AM
Details	State	Insert			Pending	4/17/2017 10:28 AM
Dates	Registration Date	Insert			4/17/2017 12:00:00 AM	4/17/2017 10:28 AM
Dates	Signed By Date	Insert			4/17/2017 12:00:00 AM	4/17/2017 10:28 AM
Dates	Start Date	Insert				4/17/2017 10:28 AM
Terminations	Termination Comments	Insert				4/17/2017 10:28 AM
Terminations	Termination Date	Insert				4/17/2017 10:28 AM
Terminations	Termination Effective Date	Insert				4/17/2017 10:28 AM
Terminations	Termination Reason	Insert				4/17/2017 10:28 AM