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DSH340113T CAROLINAS MEDICAL CENTER (Terminated)
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Main Details
Name
CAROLINAS MEDICAL CENTER
Subdivision Name
CHS CMC Behavioral Health Child and Adolescent OP
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340113T
Medicare Provider Number
340113
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/31/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/19/2012
Last Recertification Date
8/31/2016
Termination Date
Termination Reason
10/1/2017
Site closure
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
300 Billingsley Road
Charlotte, NC 28211
Billing Address
Accounts Payable
PO Box 37972
Charlotte, NC 28237
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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