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RRC340021-00 ATRIUM HEALTH CLEVELAND (Terminated)
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Main Details
Name
ATRIUM HEALTH CLEVELAND
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC340021-00
Medicare Provider Number
340021
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2021
Participating Start Date
7/1/2021
Participating Approval Date
5/7/2021
Last Recertification Date
9/9/2021
Termination Date
Termination Reason
10/1/2022
Change of covered entity type
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
201 EAST GROVER STREET
SHELBY, NC 28150
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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