Contract Pharmacy Details

ATRIUM HEALTH AT HOME INFUSION AND EQUIP
DSH340145 Atrium Health Lincoln

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

ATRIUM HEALTH AT HOME INFUSION AND EQUIP

Pharmacy Address

1701 ABBEY PL
CHARLOTTE, NC 28209-3733

Pharmacy Comments

Contract Details

Approval Date

4/16/2014

Contract Begin Date

7/1/2014

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

GLENN HUGGINS, EXECUTIVE DIRECTOR OF PHARMACY SERVICES
(704) 512-5333

Signed By Date

4/16/2014

340B Drug Pricing Program Database