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DSH340047W NORTH CAROLINA BAPTIST HOSPITAL dba Wake Forest Baptist Medical Center (Terminated)
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Main Details
Name
NORTH CAROLINA BAPTIST HOSPITAL dba Wake Forest Baptist Medical Center
Subdivision Name
DHP Ophthalmology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340047W
Medicare Provider Number
340047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/30/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/19/2012
Last Recertification Date
11/29/2017
Termination Date
Termination Reason
4/1/2018
Never implemented the 340B Program
Contacts
Authorizing Official
North Carolina Baptist Hospital
Conrad Emmerich, Sr. Vice President,Hospital & Business Services
(336) 716-8941
Primary Contact
NORTH CAROLINA BAPTIST HOSPITAL
Martin Konopko, System Manager 340b
(336) 713-9418
Addresses
Street Address
1200 N. Martin Luther King Dr.
Winston-Salem, NC 27107
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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