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ATRIUM HEALTH PHARMACY PAVILION
CAH341322-00 AdventHealth Polk
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Covered Entity Details
Entity Name
AdventHealth Polk
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH341322-00
Entity Address
101 HOSPITAL DRIVE
COLUMBUS, NC 28722
Medicare Provider Number
341322
Participating Start Date
7/1/2017
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
ATRIUM HEALTH PHARMACY PAVILION
Pharmacy Address
920 CHURCH ST N
CONCORD, NC 28025
Pharmacy Comments
Contract Details
Approval Date
4/13/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Elizabeth Presnell, CFO
(828) 894-0954
Contract Pharmacy Representative
CHS Pharmacy Services, Inc.
Kim Binion Richards, Pharmacy Director
(704) 512-7637
Signed By Date
4/13/2018
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