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CAROLINACARE
DSH340021 ATRIUM HEALTH CLEVELAND
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Covered Entity Details
Entity Name
ATRIUM HEALTH CLEVELAND
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340021
Entity Address
201 EAST GROVER STREET
SHELBY, NC 28150
Medicare Provider Number
340021
Participating Start Date
10/1/2022
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
CAROLINACARE
Pharmacy Address
4400 GOLF ACRES DR
BLDG J STE C
CHARLOTTE, NC 28208-5968
Pharmacy Comments
Contract Details
Approval Date
9/28/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/13/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Don McCoy Mabe, VP, Pharmacy
(704) 512-7623
Contract Pharmacy Representative
Atrium Health
Frank Mccree, Pharmacy Director
(704) 512-7631
Signed By Date
9/28/2022
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