340B Drug Pricing Program Database
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DSH340047AV NORTH CAROLINA BAPTIST HOSPITAL (Terminated)
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Main Details
Name
NORTH CAROLINA BAPTIST HOSPITAL
Subdivision Name
NEUROLOGY - CLEMMONS / General Neurology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340047AV
Medicare Provider Number
340047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/12/2016
Last Recertification Date
8/16/2023
Termination Date
Termination Reason
1/1/2024
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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