340B Drug Pricing Program Database
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DSH340047BG NORTH CAROLINA BAPTIST HOSPITAL (Terminated)
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Main Details
Name
NORTH CAROLINA BAPTIST HOSPITAL
Subdivision Name
OBSTETRICS & GYNECOLOGY - Gynecology Oncology PBC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH340047BG
Medicare Provider Number
340047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/6/2020
Participating Start Date
4/1/2020
Participating Approval Date
2/28/2020
Last Recertification Date
8/29/2022
Termination Date
Termination Reason
10/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
North Carolina Baptist Hospital
Michael Thomas Waid, Sr Vice President - Health System Operations and Integration
(336) 716-0433
Primary Contact
North Carolina Baptist Hospital
Bibi W Wishart, Program Director, 340B
(336) 713-3426
Addresses
Street Address
500 SHEPHERD ST
WINSTON SALEM, NC 27103-1633
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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