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DSH340113G CAROLINAS MEDICAL CENTER (Terminated)
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Main Details
Name
CAROLINAS MEDICAL CENTER
Subdivision Name
Carolinas Diabetes Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340113G
Medicare Provider Number
340113
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
9/4/2018
Termination Date
Termination Reason
4/1/2019
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Atrium Health/Charlotte-Mecklenburg Hospital Authority
Ken Haynes, President and Executive Vice President
(704) 355-6305
Primary Contact
Atrium Health
Fern Paul-Aviles, Assistant Vice President, Pharmacy
(704) 649-9691
Addresses
Street Address
1025 Morehead Medical Drive
5th floor
Charlotte, NC 28204
Billing Address
Carolinas HealthCare System Accounts Payable
PO Box 5379
Portland, OR 97228-5379
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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