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ATRIUM HEALTH PHARMACY 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
ATRIUM HEALTH PHARMACY PAVILION
Pharmacy Address
920 CHURCH ST N
CONCORD, NC 28025
Pharmacy Comments
Contract Details
Approval Date
7/6/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John J. Knox, Chief Administrative Officer
(704) 355-1116
Contract Pharmacy Representative
Atrium Health
Cole Wilson, AVP Pharmacy
(704) 512-4227
Signed By Date
7/6/2016
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