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DSH340130E ATRIUM HEALTH UNION (Terminated)
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Main Details
Name
ATRIUM HEALTH UNION
Subdivision Name
Levine Cancer Institute Radiation Oncology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340130E
Medicare Provider Number
340130
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2024
Participating Start Date
7/1/2024
Participating Approval Date
5/1/2024
Last Recertification Date
Termination Date
Termination Reason
7/1/2024
DSH percentage below statutory minimum
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
600 Hospital Drive
Suite B, Outpatient Treatment Pavilion
Monroe, NC 28112
Billing Address
Atrium Health Accounts Payable
PO Box 516
Elmsford, NY 10523
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date 10/1/2023, Termination Date 10/1/2023, Reinstatement 7/1/2024
04/30/2024
Participated starting 10/1/2016; Terminated 10/1/2022; Reinstated 10/1/2023.
09/05/2023
April 2025
April 2025
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