340B Drug Pricing Program Database
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DSH340047Y NORTH CAROLINA BAPTIST HOSPITAL (Terminated)
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Main Details
Name
NORTH CAROLINA BAPTIST HOSPITAL
Subdivision Name
Endocrinology PBC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340047Y
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
8/20/2019
Termination Date
Termination Reason
10/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
North Carolina Baptist Hospital
Conrad Emmerich, Sr. Vice President,Hospital & Business Services
(336) 716-8941
Primary Contact
North Carolina Baptist Hospital
Bibi W Wishart, Program Director, 340B
(336) 713-3426
Addresses
Street Address
4610 Country Club Rd.
Winston-Salem, NC 27104
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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