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CMC RX MATTHEWS
DSH340113F CAROLINAS MEDICAL CENTER
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Covered Entity Details
Entity Name
CAROLINAS MEDICAL CENTER
Subdivision Name
Levine Children's Specialty Center
Type
Disproportionate Share Hospital
340B ID
DSH340113F
Entity Address
1001 Blythe Blvd
Suite 200
CHARLOTTE, NC 28203
Medicare Provider Number
340113
Outpatient Facility Provider Number
Participating Start Date
4/1/2008
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
CMC RX MATTHEWS
Pharmacy Address
332 NORTH TRADE STREET
SUITE 1300
MATTHEWS, NC 28105
Pharmacy Comments
Contract Details
Approval Date
2/16/2011
Contract Begin Date
2/16/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/15/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
1/21/2011
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