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CAROLINACARE PHARMACY
DSH340021 ATRIUM HEALTH CLEVELAND
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Covered Entity Details
Entity Name
ATRIUM HEALTH CLEVELAND
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340021
Entity Address
201 EAST GROVER STREET
SHELBY, NC 28150
Medicare Provider Number
340021
Participating Start Date
10/1/2022
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
CAROLINACARE PHARMACY
Pharmacy Address
P O BOX 31691
4400 GOLF ACRES DRIVE
BUILDING J, SUITE C
CHARLOTTE, NC 28208
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
Christine Martin, VICE PRESIDENT/CFO
(980) 487-3245
Contract Pharmacy Representative
CarolinaCare
Frank McCree, Pharmacy Director
(704) 512-7621
Signed By Date
4/16/2014
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