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CMC RX MATTHEWS
DSH340113 CAROLINAS MEDICAL CENTER
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Covered Entity Details
Entity Name
CAROLINAS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340113
Entity Address
1000 BLYTHE BLVD
CHARLOTTE, NC 28203
Medicare Provider Number
340113
Participating Start Date
8/1/1993
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
10/28/2013
Contract Begin Date
1/1/2014
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
John J. Knox, Chief Administrative Officer
(704) 355-1116
Contract Pharmacy Representative
Conley McCoy, Director
(704) 512-7637
Signed By Date
10/28/2013
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