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DSH340113DM CAROLINAS MEDICAL CENTER (Approved)
Main Details
Name
CAROLINAS MEDICAL CENTER
Subdivision Name
Levine Cancer Institute - Infusion Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340113DM
Medicare Provider Number
340113
Outpatient Facility Provider Number
Contacts
Authorizing Official
Atrium Health
Don McCoy Mabe, Chief Pharmacy Officer
(704) 512-7623
Primary Contact
Atrium Health
Fern Paul-Aviles, AVP, Pharmacy
(704) 649-9691
Additional Details
Current Program Status
Approved
Registration Date
4/1/2024
Participating Start Date
7/1/2024
Participating Approval Date
4/1/2024
Last Recertification Date
Addresses
Street Address
1100 Healing Way
Suite 31
Indian Trail, NC 28104
Billing Address
Atrium Health Accounts Payable
PO Box 516
Elmsford, NY 10523
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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