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NOVANT HEALTH THOMASVILLE MEDICAL CENTER
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 THOMASVILLE MEDICAL CENTER
Pharmacy Address
DBA NOVANT HEALTH SPECIALTY PHARMACY
1381 WESTGATE CENTER DR
WINSTON SALEM, NC 27103
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
4/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paula Vincent, President and COO, Presbyterian Medical Center
(704) 384-9656
Contract Pharmacy Representative
Novant Health Pharmacy Services, LLC
Aimee Smith, Supervisor Pharmacy
(336) 718-1460
Signed By Date
10/28/2016
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