| Details | State | Update | | Approved | Active | 1/1/2025 12:01 AM |
| Addresses | Billing Address | Insert | Reinstatement | | Gaston Memorial Hospital
Po Box 1747
Gastonia, NC 28053 | 11/25/2024 6:48 AM |
| Details | Last Recertification Date | Update | Reinstatement | 8/29/2023 9:16:03 AM | | 11/25/2024 6:48 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 11/29/2023 12:00:00 AM | | 11/25/2024 6:48 AM |
| Dates | Participating Approval Date | Update | Reinstatement | 7/24/2017 12:00:00 AM | 11/25/2024 6:48:39 AM | 11/25/2024 6:48 AM |
| Details | State | Update | Reinstatement | Terminated | Approved | 11/25/2024 6:48 AM |
| Dates | Registration Date | Update | Reinstatement | 7/14/2017 12:00:00 AM | 10/14/2024 3:20:12 PM | 11/25/2024 6:48 AM |
| Dates | Signed By Date | Update | Reinstatement | 7/14/2017 12:00:00 AM | 11/22/2024 1:16:21 PM | 11/25/2024 6:48 AM |
| Dates | Start Date | Update | Reinstatement | 3/15/2022 12:00:00 AM | 1/1/2025 12:00:00 AM | 11/25/2024 6:48 AM |
| Terminations | Termination Date | Update | Reinstatement | 1/1/2024 12:00:00 AM | | 11/25/2024 6:48 AM |
| Terminations | Termination Effective Date | Update | Reinstatement | 11/30/2023 12:00:00 AM | | 11/25/2024 6:48 AM |
| Terminations | Termination Reason | Update | Reinstatement | DSH percentage below statutory minimum | | 11/25/2024 6:48 AM |
| Details | Comments Public | Insert | Reinstatement | | Participated starting 3/15/2022; Terminated 1/1/2024; Reinstated 1/1/2025. | 11/22/2024 1:39 PM |
| Details | State | Update | | To Be Terminated | Terminated | 1/1/2024 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 11/29/2023 12:00:00 AM | 11/30/2023 1:22 PM |
| Details | State | Update | Termination Request | Active | To Be Terminated | 11/30/2023 1:22 PM |
| Terminations | Termination Date | Update | Termination Request | | 1/1/2024 12:00:00 AM | 11/30/2023 1:22 PM |
| Terminations | Termination Effective Date | Update | Termination Request | | 11/30/2023 12:00:00 AM | 11/30/2023 1:22 PM |
| Terminations | Termination Reason | Update | Termination Request | | DSH percentage below statutory minimum | 11/30/2023 1:22 PM |
| Details | Last Recertification Date | Update | Recertification | 8/31/2022 4:11:27 PM | 8/29/2023 9:16:03 AM | 8/29/2023 9:16 AM |
| Details | Last Recertification Date | Update | Recertification | 8/23/2021 1:23:43 PM | 8/31/2022 4:11:27 PM | 8/31/2022 4:11 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | COVID-19 Reinstatement | 11/30/2021 12:00:00 AM | | 3/29/2022 5:02 PM |
| Details | State | Update | COVID-19 Reinstatement | Terminated | Active | 3/29/2022 5:02 PM |
| Dates | Start Date | Update | COVID-19 Reinstatement | 10/1/2017 12:00:00 AM | 3/15/2022 12:00:00 AM | 3/29/2022 5:02 PM |
| Terminations | Termination Date | Update | COVID-19 Reinstatement | 1/1/2022 12:00:00 AM | | 3/29/2022 5:02 PM |
| Terminations | Termination Effective Date | Update | COVID-19 Reinstatement | 11/30/2021 12:00:00 AM | | 3/29/2022 5:02 PM |
| Terminations | Termination Reason | Update | COVID-19 Reinstatement | DSH percentage below statutory minimum | | 3/29/2022 5:02 PM |
| Details | State | Update | | To Be Terminated | Terminated | 1/1/2022 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 11/30/2021 12:00:00 AM | 12/1/2021 11:57 AM |
| Details | State | Update | Termination Request | Active | To Be Terminated | 12/1/2021 11:57 AM |
| Terminations | Termination Date | Update | Termination Request | | 1/1/2022 12:00:00 AM | 12/1/2021 11:57 AM |
| Terminations | Termination Effective Date | Update | Termination Request | | 11/30/2021 12:00:00 AM | 12/1/2021 11:57 AM |
| Terminations | Termination Reason | Update | Termination Request | | DSH percentage below statutory minimum | 12/1/2021 11:57 AM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2020 9:45:26 AM | 8/23/2021 1:23:43 PM | 8/23/2021 1:23 PM |
| Addresses | Billing Address | Insert | Change Request | | Gaston Memorial Hospital
Po Box 1747
Gastonia, NC 28053 | 3/11/2021 2:35 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 3/11/2021 2:35 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 340032 | 3/11/2021 2:35 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | SC | 3/11/2021 2:35 PM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 460595 (SC) | | 3/11/2021 2:35 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Chaparro, Mark
Pharmacy Director
Gaston Memorial Hospital
7048342239 | Chaparro, Mark
Pharmacy Director
CaroMont Regional Medical Center
7048342239 | 9/10/2020 9:59 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1013918960 | 8/26/2020 9:45 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | SC | 8/26/2020 9:45 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | NC | 8/26/2020 9:45 AM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2019 2:33:23 PM | 8/26/2020 9:45:26 AM | 8/26/2020 9:45 AM |
| Details | Last Recertification Date | Update | Recertification | 8/29/2018 9:48:44 AM | 8/26/2019 2:33:23 PM | 8/26/2019 2:33 PM |
| Details | Last Recertification Date | Update | Recertification | 11/6/2017 10:07:01 AM | 8/29/2018 9:48:44 AM | 8/29/2018 9:48 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 3/2/2018 8:37 AM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 3400032 | 3/2/2018 8:37 AM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | NC | 3/2/2018 8:37 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 3/2/2018 8:37 AM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 460595 | 3/2/2018 8:37 AM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | SC | 3/2/2018 8:37 AM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1013918960 | 3/2/2018 8:37 AM |
| Details | Last Recertification Date | Update | Recertification | | 11/6/2017 10:07:01 AM | 11/6/2017 10:07 AM |
| Contacts | Authorizing Official | Update | | O’Connor, David
CFO
7048342127 | O’Connor, David
CFO
Caromont Regional Medical Center
7048342127 | 10/20/2017 9:53 AM |
| Contacts | Signed By | Update | | O’Connor, David
CFO
7048342127 | O’Connor, David
CFO
Caromont Regional Medical Center
7048342127 | 10/20/2017 9:53 AM |
| Contacts | Primary Contact | Update | | Chaparro, Mark
Pharmacy Director
7048342239 | Chaparro, Mark
Pharmacy Director
Gaston Memorial Hospital
7048342239 | 10/5/2017 4:35 PM |
| Contacts | Primary Contact | Insert | | | Chaparro, Mark
Pharmacy Director
7048342239 | 7/24/2017 5:42 PM |
| Contacts | Authorizing Official | Insert | | | O’Connor, David
CFO
7048342127 | 7/24/2017 5:42 PM |
| Contacts | Signed By | Insert | | | O’Connor, David
CFO
7048342127 | 7/24/2017 5:42 PM |
| Addresses | Main Address | Insert | | |
451 EAST CHARLOTTE AVENUE
MT. HOLLY, NC 28120-2211 | 7/24/2017 5:42 PM |
| Details | State | Update | | Approved | Active | 7/24/2017 5:42 PM |
| Details | Entity Subname | Update | | CAROMONT REGIONAL MEDICAL CENTER-MT | CAROMONT REGIONAL MEDICAL CENTER-MT / EMERGENCY | 7/24/2017 5:42 PM |
| Dates | Participating Approval Date | Update | | | 7/24/2017 12:00:00 AM | 7/24/2017 5:40 PM |
| Details | State | Update | | Pending | Approved | 7/24/2017 5:40 PM |
| Dates | Start Date | Update | | | 10/1/2017 12:00:00 AM | 7/24/2017 5:40 PM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_78563 | DSH340032M | 7/14/2017 10:20 AM |
| Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_78563 | 7/14/2017 8:36 AM |
| Details | Last Recertification Date | Insert | | | | 7/14/2017 8:36 AM |
| Details | Grant Number | Insert | | | | 7/14/2017 8:36 AM |
| Details | 340B ID | Insert | | | | 7/14/2017 8:36 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 7/14/2017 8:36 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/14/2017 8:36 AM |
| Details | Medicare Provider Number | Insert | | | 340032 | 7/14/2017 8:36 AM |
| Details | Entity Name | Insert | | | GASTON MEMORIAL HOSPITAL | 7/14/2017 8:36 AM |
| Details | Program Code | Insert | | | DSH | 7/14/2017 8:36 AM |
| Details | Entity Subname | Insert | | | CAROMONT REGIONAL MEDICAL CENTER-MT | 7/14/2017 8:36 AM |
| Dates | Participating Approval Date | Insert | | | | 7/14/2017 8:36 AM |
| Details | State | Insert | | | Pending | 7/14/2017 8:36 AM |
| Dates | Registration Date | Insert | | | 7/14/2017 12:00:00 AM | 7/14/2017 8:36 AM |
| Dates | Signed By Date | Insert | | | 7/14/2017 12:00:00 AM | 7/14/2017 8:36 AM |
| Dates | Start Date | Insert | | | | 7/14/2017 8:36 AM |
| Terminations | Termination Comments | Insert | | | | 7/14/2017 8:36 AM |
| Terminations | Termination Date | Insert | | | | 7/14/2017 8:36 AM |
| Terminations | Termination Effective Date | Insert | | | | 7/14/2017 8:36 AM |
| Terminations | Termination Reason | Insert | | | | 7/14/2017 8:36 AM |