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DSH340047AX NORTH CAROLINA BAPTIST HOSPITAL (Active)
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Main Details
Name
NORTH CAROLINA BAPTIST HOSPITAL
Subdivision Name
VEIN SERVICES CLEMMONS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340047AX
Medicare Provider Number
340047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/12/2016
Last Recertification Date
8/23/2024
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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