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DSH340113BA CAROLINAS MEDICAL CENTER (Terminated)
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Main Details
Name
CAROLINAS MEDICAL CENTER
Subdivision Name
CMC-Mercy Endoscopy
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340113BA
Medicare Provider Number
340113
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2014
Participating Start Date
7/1/2014
Participating Approval Date
5/8/2014
Last Recertification Date
8/26/2014
Termination Date
Termination Reason
7/1/2015
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
2001 Vail Avenue
Charlotte, NC 28207
Billing Address
Carolinas Medical Center A/P
PO Box 32861
Charlotte, NC 28232
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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