Contract Pharmacy Details

CAROLINACARE
DSH340021 ATRIUM HEALTH CLEVELAND

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 Address

4400 GOLF ACRES DR
BLDG J STE C
CHARLOTTE, NC 28208-5968

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

CarolinaCare
Frank McCree, Pharmacy Director
(704) 512-7621

Signed By Date

1/15/2018

340B Drug Pricing Program Database