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ATRIUM HEALTH PHARMACY PAVILION
DSH340145 Atrium Health Lincoln
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Covered Entity Details
Entity Name
Atrium Health Lincoln
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340145
Entity Address
433 MCALISTER ROAD
LINCOLNTON, NC 28092
Medicare Provider Number
340145
Participating Start Date
7/1/2004
Last Recertification Date
9/14/2020
Entity Termination Date
10/1/2021
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
10/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Scott Leighty, Senior Vice President
(704) 512-2414
Contract Pharmacy Representative
CHS Pharmacy Services, Inc.
Kim Binion Richards, Pharmacy Director
(704) 512-7637
Signed By Date
1/15/2018
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