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ATRIUM HEALTH PHARMACY SOUTHPARK
DSH340130 ATRIUM HEALTH UNION
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Covered Entity Details
Entity Name
ATRIUM HEALTH UNION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340130
Entity Address
600 HOSPITAL DRIVE
MONROE, NC 28111
Medicare Provider Number
340130
Participating Start Date
7/1/2024
Last Recertification Date
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
ATRIUM HEALTH PHARMACY SOUTHPARK
Pharmacy Address
4525 CAMERON VALLEY PKWY
STE 1200
CHARLOTTE, NC 28211
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Scott Leighty, Senior Vice President
(704) 512-2414
Contract Pharmacy Representative
Atrium Health
Kim Binionrichards, Pharmacy Director
(704) 512-7637
Signed By Date
1/15/2020
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