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CMC RX MEDICAL CENTER PLAZA
DSH340145 Atrium Health Lincoln
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Covered Entity Details
Entity Name
Atrium Health Lincoln
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340145
Entity Address
433 MCALISTER ROAD
LINCOLNTON, NC 28092
Medicare Provider Number
340145
Participating Start Date
7/1/2004
Last Recertification Date
9/14/2020
Entity Termination Date
10/1/2021
Pharmacy Details
Pharmacy Name
CMC RX MEDICAL CENTER PLAZA
Pharmacy Address
1001 BLYTHE BLVD
SUITE 201
CHARLOTTE, NC 28203
Pharmacy Comments
Contract Details
Approval Date
1/15/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2016
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
1/15/2014
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