Covered Entity Details

DSH340070Y ALAMANCE REGIONAL MEDICAL CENTER (Terminated) - information as of 6/14/2025 10:00:39 AM

Main Details

Name

ALAMANCE REGIONAL MEDICAL CENTER

Subdivision Name

CONE HEALTH CANCER CENTER AT ALAMANCE REGIONAL - Radiation Therapy

Type

Disproportionate Share Hospital

Rural

340B ID

DSH340070Y

Medicare Provider Number

340070

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/14/2021

Participating Start Date

4/1/2021

Participating Approval Date

2/19/2021

Last Recertification Date

9/6/2022

Termination Date
Termination Reason

1/1/2023
Business decision by the Covered Entity

Contacts

Authorizing Official

Cone Health
Andrew Barrow, Chief Financial Officer
(336) 832-7825

Primary Contact

Cone Health
Alex Kidd, Pharmacy Business Manager
(336) 890-3625

Addresses

Street Address

1236 Huffman Mill Road
Suite 120
Burlington, NC 27215

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	340070	1326010273

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
DSH340070A	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	MEDCENTER MEBANE SURGERY CENTER	3940 ARROWHEAD BLVD.	MEBANE	NC	Terminated
DSH340070B	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	Graham Outpatient Imaging	1205 SOUTH MAIN STREET	GRAHAM	NC	Terminated
DSH340070C	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	CONE HEALTH CANCER CENTER AT ALAMANCE REGIONAL	1236 HUFFMAN MILL RD, Suite 120	BURLINGTON	NC	Terminated
DSH340070D	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	WOUND HEALING CENTER AT ALAMANCE REGIONAL	1248 HUFFMAN MILL ROAD	BURLINGTON	NC	Terminated
DSH340070E	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	CONE HEALTH CANCER CENTER AT MEDCENTER MEBANE	3940 ARROWHEAD BLVD.	MEBANE	NC	Terminated
DSH340070F	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	SLEEP DISORDER CENTER AT ALAMANCE REGIONAL	1248 HUFFMAN MILL ROAD	BURLINGTON	NC	Terminated
DSH340070G	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	Physical and Sports Rehabilitation Clinic	2282 SOUTH CHURCH STREET	BURLINGTON	NC	Terminated
DSH340070H	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	CONE HEALTH MEBANE PHYSICAL THERAPY	102-A MEDICAL PARK DRIVE	MEBANE	NC	Terminated
DSH340070J	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	Alamance Regional Outpatient Imaging Center / Diagnostic Radiology	2903 Professional Park Drive, Suite B	Burlington	NC	Terminated
DSH340070K	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	Alamance Regional Outpatient Imaging Center / Radioisotope	2903 Professional Park Drive, Suite B	Burlington	NC	Terminated
DSH340070L	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	Alamance Regional Outpatient Imaging Center / CT Scan	2903 Professional Park Drive, Suite B	Burlington	NC	Terminated
DSH340070M	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	Cone Health Pediatric Rehabilitation Center at Burlington/Physical Therapy	519 Boone Station, Suite 108	Burlington	NC	Terminated
DSH340070N	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	Cone Health Pediatric Rehabilitation Center at Burlington/Occupational Therapy	519 Boone Station, Suite 108	Burlington	NC	Terminated
DSH340070P	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	Cone Health Pediatric Rehabilitation Center at Burlington/Speech Pathology	519 Boone Station, Suite 108	Burlington	NC	Terminated
DSH340070Q	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	Alamance Regional Pain Clinic	1236 Huffman Mill Road, Suite 2000	Burlington	NC	Terminated
DSH340070R	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	Nutrition and Diabetes Education Services at Alamance Regional	1238 Grand Oaks Blvd	BURLINGTON	NC	Terminated
DSH340070S	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	Physical and Sports Rehabilitation Clinic / Occupational Therapy	2282 South Church Street	Burlington	NC	Terminated
DSH340070T	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	Cone Health Imaging at MedCenter Mebane/Diagnostic Radiology	3940 Arrowhead Blvd	Mebane	NC	Terminated
DSH340070V	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	Cone Health Imaging at MedCenter Mebane/ CT Scan	3940 Arrowhead Blvd	Mebane	NC	Terminated
DSH340070W	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	HEART FAILURE CLINIC AT ALAMANCE REGIONAL MEDICAL CENTER - HEART FAILURE	1236 Huffman Mill Road, Suite 2100	Burlington	NC	Terminated
DSH340070X	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	Alamance Regional Medical Center Infectious Disease - Infectious Disease	1236 Huffman Mill Road	Burlington	NC	Terminated
DSH340070Y	Child	DSH	ALAMANCE REGIONAL MEDICAL CENTER	CONE HEALTH CANCER CENTER AT ALAMANCE REGIONAL - Radiation Therapy	1236 Huffman Mill Road	Burlington	NC	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Kidd, Alex Pharmacy Business Manager Cone Health 3368322124	Kidd, Alex Pharmacy Business Manager Cone Health 3368903625	4/16/2024 2:16 PM
Details	State	Update		To Be Terminated	Terminated	1/1/2023 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		11/30/2022 12:00:00 AM	12/5/2022 6:56 AM
Details	State	Update	Termination Request	Active	To Be Terminated	12/5/2022 6:56 AM
Terminations	Termination Date	Update	Termination Request		1/1/2023 12:00:00 AM	12/5/2022 6:56 AM
Terminations	Termination Effective Date	Update	Termination Request		12/1/2022 12:00:00 AM	12/5/2022 6:56 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	12/5/2022 6:56 AM
Details	Last Recertification Date	Update	Recertification	8/31/2021 12:18:47 PM	9/6/2022 10:13:48 AM	9/6/2022 10:13 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	403163 (SC)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1326010273 (VA)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	000499012X (GA)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	02204451 (NY)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	418679600 (MD)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	097584200 (FL)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	032067300 (DC)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	4172701 (NJ)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	2999573 (OH)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1326010273 (CA)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1326010273 (MI)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	072533502 (TX)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1326010273 (WV)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	01520634 (KY)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	003050515 (CT)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	340070 (TN)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	752548221 (AL)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1326010273 (WA)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	200913450A (IN)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1326010273 (IA)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1326010273 (MN)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1326010273 (ID)		8/31/2021 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1326010273 (SD)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (SC)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (VA)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (GA)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (NY)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (MD)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (FL)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (DC)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (NJ)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (OH)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (CA)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (MI)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (TX)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (WV)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (KY)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (CT)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (TN)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (AL)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (WA)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (IN)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (IA)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (MN)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (ID)		8/31/2021 12:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326010273 (SD)		8/31/2021 12:18 PM
Details	Last Recertification Date	Update	Recertification		8/31/2021 12:18:47 PM	8/31/2021 12:18 PM
Details	State	Update		Approved	Active	4/1/2021 12:01 AM
Contacts	Authorizing Official	Update	AO Change Request	Jones, Jeffrey Executive VP and CFO Cone Health 3368328005	Barrow, Andrew Chief Financial Officer Cone Health 3368327825	3/8/2021 2:40 PM
Contacts	Signed By	Insert	New Registration		Jones, Jeffrey Executive VP and CFO Cone Health 3368328005	2/19/2021 9:30 AM
Details	340B ID	Update	New Registration		DSH340070Y	2/19/2021 9:30 AM
Details	Entity Subname	Update	New Registration	CONE HEALTH CANCER CENTER AT ALAMANCE REGIONAL	CONE HEALTH CANCER CENTER AT ALAMANCE REGIONAL - Radiation Therapy	2/19/2021 9:30 AM
Dates	Participating Approval Date	Update	New Registration		2/19/2021 9:30:59 AM	2/19/2021 9:30 AM
Details	State	Update	New Registration	Pending	Approved	2/19/2021 9:30 AM
Dates	Signed By Date	Update	New Registration		1/14/2021 11:20:43 AM	2/19/2021 9:30 AM
Dates	Start Date	Update	New Registration		4/1/2021 12:00:00 AM	2/19/2021 9:30 AM
Addresses	Main Address	Insert	New Registration		1236 Huffman Mill Road Suite 120 Burlington, NC 27215	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		340070	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		NC	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		403163	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		SC	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		VA	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		000499012X	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		GA	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		02204451	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		418679600	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MD	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		097584200	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		FL	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		032067300	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		DC	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		4172701	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		NJ	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		2999573	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		OH	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		CA	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MI	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		072533502	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		WV	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		01520634	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		003050515	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		CT	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		340070	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		TN	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		752548221	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		AL	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		WA	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		200913450A	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		IN	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		IA	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MN	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		ID	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		SD	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		NC	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		SC	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		VA	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		GA	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		NY	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		MD	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		FL	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		DC	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		NJ	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		OH	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		CA	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		MI	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		TX	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		WV	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		KY	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		CT	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		TN	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		AL	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		WA	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		IN	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		MN	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		ID	1/14/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326010273	1/14/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		SD	1/14/2021 10:56 AM
Contacts	Authorizing Official	Insert	New Registration		Jones, Jeffrey Executive VP and CFO Cone Health 3368328005	1/14/2021 10:56 AM
Contacts	Primary Contact	Insert	New Registration		Kidd, Alex Pharmacy Business Manager Cone Health 3368322124	1/14/2021 10:56 AM
Details	Assistance Received From Date	Insert	New Registration			1/14/2021 10:56 AM
Details	Assistance Received To Date	Insert	New Registration			1/14/2021 10:56 AM
Details	Last Recertification Date	Insert	New Registration			1/14/2021 10:56 AM
Details	Grant Number	Insert	New Registration			1/14/2021 10:56 AM
Details	340B ID	Insert	New Registration			1/14/2021 10:56 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/14/2021 10:56 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/14/2021 10:56 AM
Details	Medicare Provider Number	Insert	New Registration		340070	1/14/2021 10:56 AM
Details	Entity Name	Insert	New Registration		ALAMANCE REGIONAL MEDICAL CENTER	1/14/2021 10:56 AM
Details	NOFO Number	Insert	New Registration			1/14/2021 10:56 AM
Details	Program Code	Insert	New Registration		DSH	1/14/2021 10:56 AM
Details	Entity Subname	Insert	New Registration		CONE HEALTH CANCER CENTER AT ALAMANCE REGIONAL	1/14/2021 10:56 AM
Dates	Participating Approval Date	Insert	New Registration			1/14/2021 10:56 AM
Details	State	Insert	New Registration		Pending	1/14/2021 10:56 AM
Dates	Registration Date	Insert	New Registration		1/14/2021 10:56:11 AM	1/14/2021 10:56 AM
Dates	Signed By Date	Insert	New Registration			1/14/2021 10:56 AM
Dates	Start Date	Insert	New Registration			1/14/2021 10:56 AM
Terminations	Termination Comments	Insert	New Registration			1/14/2021 10:56 AM
Terminations	Termination Date	Insert	New Registration			1/14/2021 10:56 AM
Terminations	Termination Effective Date	Insert	New Registration			1/14/2021 10:56 AM
Terminations	Termination Reason	Insert	New Registration			1/14/2021 10:56 AM