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NOVANT HEALTH PHARMACY SERVICES LLC
DSH340053 Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center
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Covered Entity Details
Entity Name
Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340053
Entity Address
200 HAWTHORNE LANE
CHARLOTTE, NC 28204
Medicare Provider Number
340053
Participating Start Date
4/1/2008
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
NOVANT HEALTH PHARMACY SERVICES LLC
Pharmacy Address
DBA: NOVANT HEALTH PHARMACY
200 HAWTHORNE ROAD
CHARLOTTE, NC 28204
Pharmacy Comments
Contract Details
Approval Date
10/28/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/11/2019
Ownership change
Contacts
Covered Entity Signing Official
Paula Vincent, President and COO, Presbyterian Medical Center
(704) 384-9656
Contract Pharmacy Representative
Chickham Syvanthong, Supervisor Retail Pharmacy
(704) 384-9065
Signed By Date
10/28/2016
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