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ATRIUM HEALTH PHARMACY PAVILION
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
ATRIUM HEALTH PHARMACY PAVILION
Pharmacy Address
920 CHURCH ST N
CONCORD, NC 28025
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Scott Leighty, Senior Vice President
(704) 512-2414
Contract Pharmacy Representative
Atrium Health
Cole Wilson, AVP Pharmacy
(704) 512-4227
Signed By Date
1/15/2018
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