340B Drug Pricing Program Database
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DSH340047AH NORTH CAROLINA BAPTIST HOSPITAL (Terminated)
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Main Details
Name
NORTH CAROLINA BAPTIST HOSPITAL
Subdivision Name
Clemmons - Benign Breast
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340047AH
Medicare Provider Number
340047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2013
Participating Start Date
7/1/2013
Participating Approval Date
5/15/2013
Last Recertification Date
8/17/2021
Termination Date
Termination Reason
4/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
North Carolina Baptist Hospital
Michael Thomas Waid, Sr Vice President - Health System Operations and Integration
(336) 716-0433
Primary Contact
North Carolina Baptist Hospital
Bibi W Wishart, Program Director, 340B
(336) 713-3426
Addresses
Street Address
2341 Lewisville-Clemmons Rd
Clemmons, NC 27012
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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