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CMC RX PAVILION
DSH340001 ATRIUM HEALTH CABARRUS
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Covered Entity Details
Entity Name
ATRIUM HEALTH CABARRUS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340001
Entity Address
920 CHURCH STREET NORTH
CONCORD, NC 28025-2927
Medicare Provider Number
340001
Participating Start Date
7/1/2024
Last Recertification Date
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
CMC RX PAVILION
Pharmacy Address
920 CHURCH STREET, NORTH
CONCORD, NC 28025
Pharmacy Comments
Contract Details
Approval Date
10/28/2013
Contract Begin Date
1/1/2014
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
10/28/2013
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