340B Drug Pricing Program Database
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DSH340130C Atrium Health Union (Terminated)
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Main Details
Name
Atrium Health Union
Subdivision Name
Levine Cancer Institute / Infusion Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340130C
Medicare Provider Number
340130
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2016
Participating Start Date
7/1/2016
Participating Approval Date
5/5/2016
Last Recertification Date
9/9/2021
Termination Date
Termination Reason
4/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Atrium Health
Don McCoy Mabe, VP, Pharmacy
(704) 512-7623
Primary Contact
Atrium Health
Fern Paul-Aviles, AVP, Pharmacy
(704) 649-9691
Addresses
Street Address
1550 Faulk Street
Suite 1500
Monroe, NC 28112
Billing Address
Atrium Health Accounts Payable
PO Box 5379
Portland, OR 97228-5379
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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