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CMC RX PAVILION
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 PAVILION
Pharmacy Address
920 CHURCH STREET, NORTH
CONCORD, NC 28025
Pharmacy Comments
Contract Details
Approval Date
7/17/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/29/2016
Ownership change
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
7/17/2014
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