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DSH340113CC CAROLINAS MEDICAL CENTER (Terminated)
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Main Details
Name
CAROLINAS MEDICAL CENTER
Subdivision Name
Atrium Health Heart Failure (CHF) Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340113CC
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
8/23/2016
Last Recertification Date
9/9/2020
Termination Date
Termination Reason
10/1/2021
Hospital Outpatient facility no longer eligible
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
1025 Medical Center Drive
Suite 600
Charlotte, NC 28204
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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