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DSH340113CD CAROLINAS MEDICAL CENTER (Terminated)
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Main Details
Name
CAROLINAS MEDICAL CENTER
Subdivision Name
Levine Cancer Institute Infusion Center (0001 331300)
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340113CD
Medicare Provider Number
340113
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2016
Participating Start Date
10/1/2016
Participating Approval Date
9/8/2016
Last Recertification Date
9/4/2018
Termination Date
Termination Reason
10/1/2019
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
1401 Matthews Township Pkwy
Suite 208
Matthews, NC 28105
Billing Address
Carolinas HealthCare System Accounts Payable
PO Box 5379
Portland, OR 97228-5379
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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