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RRC340021-01 ATRIUM HEALTH CLEVELAND (Terminated)
Main Details
Name
ATRIUM HEALTH CLEVELAND
Subdivision Name
Levine Cancer Institute - Infusion Center (1111 10049 32690)
Type
Rural Referral Center
Rural
Yes
340B ID
RRC340021-01
Medicare Provider Number
340021
Outpatient Facility Provider Number
Contacts
Authorizing Official
Atrium Health
Don McCoy Mabe, Chief Pharmacy Officer
(704) 512-7623
Primary Contact
Atrium Health
Fern Paul-Aviles, AVP, Pharmacy
(704) 649-9691
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
1/1/2022
Termination Reason
Business decision by the Covered Entity
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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