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CAROLINACARE PHARMACY
DSH340166 Atrium Health University City
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Covered Entity Details
Entity Name
Atrium Health University City
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340166
Entity Address
8800 North Tryon Street
Charlotte, NC 28262
Medicare Provider Number
340166
Participating Start Date
4/1/2012
Last Recertification Date
9/4/2024
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
John J. Knox, Chief Administrative Officer
(704) 355-1116
Contract Pharmacy Representative
CarolinaCare
Frank McCree, Pharmacy Director
(704) 512-7621
Signed By Date
4/16/2014
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