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DSH340113AK CAROLINAS MEDICAL CENTER (Terminated)
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Main Details
Name
CAROLINAS MEDICAL CENTER
Subdivision Name
CMC NorthPark After-Hours Pediatric Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340113AK
Medicare Provider Number
340113
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2014
Participating Start Date
4/1/2014
Participating Approval Date
3/5/2014
Last Recertification Date
9/1/2015
Termination Date
Termination Reason
7/1/2016
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
251 Eastway Drive
Charlotte, NC 28213-7103
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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