340B Drug Pricing Program Database
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DSH340047BA NORTH CAROLINA BAPTIST HOSPITAL (Terminated)
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Main Details
Name
NORTH CAROLINA BAPTIST HOSPITAL
Subdivision Name
Brenner Children's Specialty Services - Clemmons
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340047BA
Medicare Provider Number
340047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2017
Participating Start Date
4/1/2017
Participating Approval Date
3/3/2017
Last Recertification Date
8/16/2018
Termination Date
Termination Reason
7/1/2019
Other
Contacts
Authorizing Official
North Carolina Baptist Hospital
Conrad Emmerich, Sr. Vice President,Hospital & Business Services
(336) 716-8941
Primary Contact
North Carolina Baptist Hospital
Bibi W Wishart, Program Director, 340B
(336) 713-3426
Addresses
Street Address
2311 Lewisville-Clemmons Rd, 3rd Floor
Clemmons, NC 27012
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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