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ATRIUM HEALTH PHARMACY PAVILION
DSH340001 ATRIUM HEALTH CABARRUS
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Covered Entity Details
Entity Name
ATRIUM HEALTH CABARRUS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340001
Entity Address
920 CHURCH STREET NORTH
CONCORD, NC 28025-2927
Medicare Provider Number
340001
Participating Start Date
7/1/2024
Last Recertification Date
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
ATRIUM HEALTH PHARMACY PAVILION
Pharmacy Address
920 CHURCH ST N
CONCORD, NC 28025
Pharmacy Comments
Contract Details
Approval Date
12/1/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Don McCoy Mabe, VP, Pharmacy
(704) 512-7623
Contract Pharmacy Representative
Atrium Health
Cole Wilson, AVP Pharmacy
(704) 512-4227
Signed By Date
10/14/2021
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