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DSH340113D CAROLINAS MEDICAL CENTER (Terminated)
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Main Details
Name
CAROLINAS MEDICAL CENTER
Subdivision Name
Atrium Health Myers Park Infectious Diseases Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340113D
Medicare Provider Number
340113
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/1/2008
Participating Start Date
7/1/2001
Participating Approval Date
3/1/2008
Last Recertification Date
9/9/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Atrium Health
Don McCoy Mabe, VP, Pharmacy
(704) 512-7623
Primary Contact
Atrium Health
Fern Paul-Aviles, AVP, Pharmacy
(704) 649-9691
Addresses
Street Address
1350 SOUTH KINGS DRIVE
3rd floor
CHARLOTTE, NC 28207-2134
Billing Address
Atrium Health Accounts Payable
PO Box 5379
Portland, OR 97228-5379
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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03/01/2012 ADDRESS OF 1000 BLYTHE BLVD MOVED TO PARENT ID (DSH340113)
03/01/2012
03/01/2012 Termination request received.
03/01/2012
April 2025
April 2025
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