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CAROLINACARE
DSH110054 ATRIUM HEALTH FLOYD MEDICAL CENTER
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Covered Entity Details
Entity Name
ATRIUM HEALTH FLOYD MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110054
Entity Address
304 TURNER MCCALL BLVD
ROME, GA 30165
Medicare Provider Number
110054
Participating Start Date
7/1/2004
Last Recertification Date
8/16/2024
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
10/13/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clarice Cable, AVP of Finance
(706) 509-6078
Contract Pharmacy Representative
Atrium Health
Cole Wilson, AVP Pharmacy
(704) 512-4227
Signed By Date
10/13/2022
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