Covered Entity Details

CAH491304-04 CARILION ROCKBRIDGE COMMUNITY HOSPITAL (Active) - information as of 6/12/2025 6:05:38 AM

Main Details

Name

CARILION ROCKBRIDGE COMMUNITY HOSPITAL

Subdivision Name

Carilion Family Medicine Buchanan - Carilion Family Medicine Buchanan

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH491304-04

Medicare Provider Number

491304

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/14/2021

Participating Start Date

10/1/2021

Participating Approval Date

8/5/2021

Last Recertification Date

9/5/2024

Contacts

Authorizing Official

Carilion Clinic
Tim Auwarter, VP Hospital Operations
(540) 981-7804

Primary Contact

Carilion
Trina Epperly, 340B Program Director
(540) 224-3004

Addresses

Street Address

18080 Main Street
Buchanan, VA 24066

Billing Address

Carilion Rockbridge Community Hospital
1 Health Circle
Lexington, VA 24450

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
VA	491304	1144848003,1518950484
NC		1518950484,1144848003
WV		1518950484,1144848003

Shipping Addresses

Shipping Address 1

Carilion Rockbridge Community Hospital
1 Health Circle
Pharmacy Department
Lexington, VA 24450

Shipping Address 2

Carilion Medical Center - Central Pharmacy Distribution
2823 Franklin Rd, SW
Bldg C
Roanoke, VA 24014

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH491304-01	Child	CAH	CARILION ROCKBRIDGE COMMUNITY HOSPITAL	CARILION FAMILY MEDICINE - Lexington South Main	146 S Main St #3	LEXINGTON	VA	ToBeTerminated
CAH491304-02	Child	CAH	CARILION ROCKBRIDGE COMMUNITY HOSPITAL	Carilion Family Medicine / Lexington	108 HOUSTON ST	LEXINGTON	VA	Active
CAH491304-03	Child	CAH	CARILION ROCKBRIDGE COMMUNITY HOSPITAL	Carilion Clinic / Internal Medicine - Lexington	108 HOUSTON ST	LEXINGTON	VA	Active
CAH491304-04	Child	CAH	CARILION ROCKBRIDGE COMMUNITY HOSPITAL	Carilion Family Medicine Buchanan - Carilion Family Medicine Buchanan	18080 Main Street	Buchanan	VA	Active
CAH491304-05	Child	CAH	CARILION ROCKBRIDGE COMMUNITY HOSPITAL	Carilion Family Medicine Buena Vista - Carilion Family Medicine Buena Vista	2252 Magnolia Ave	Buena Vista	VA	Active
CAH491304-06	Child	CAH	CARILION ROCKBRIDGE COMMUNITY HOSPITAL	Carilion Family Medicine Bedford - Carilion Family Medicine Bedford	548 Blue Ridge Ave	Bedford	VA	Active
CAH491304-07	Child	CAH	CARILION ROCKBRIDGE COMMUNITY HOSPITAL	Carilion Cardiology Lexington - Carilion Cardiology Lexington	108 Houston St. Suite E	Lexington	VA	Active
CAH491304-08	Child	CAH	CARILION ROCKBRIDGE COMMUNITY HOSPITAL	Carilion Family Medicine Clifton Forge - Carilion Family Medicine Clifton Forge	609 Church St	Clifton Forge	VA	Active
CAH491304-09	Child	CAH	CARILION ROCKBRIDGE COMMUNITY HOSPITAL	Carilion Neurology - Lexington - Neurology	108 Houston St	Lexington	VA	Terminated
CAH491304-10	Child	CAH	CARILION ROCKBRIDGE COMMUNITY HOSPITAL	Carilion General Surgery - Clifton Forge Rural Health - Carilion General Surgery- Clifton Forge Rural Health	609 Church St	Clifton Forge	VA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/10/2023 12:17:36 PM	9/5/2024 1:28:19 PM	9/5/2024 1:28 PM
Addresses	Shipping Address	Delete	Group Change Request	Carilion Medical Center - Central Pharmacy Distribution 2823 Franklin Rd, SW Bldg A Roanoke, VA 24014		8/6/2024 11:13 AM
Addresses	Shipping Address	Insert	Group Change Request		Carilion Medical Center - Central Pharmacy Distribution 2823 Franklin Rd, SW Bldg C Roanoke, VA 24014	8/6/2024 11:13 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1144848003	5/6/2024 1:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		NC	5/6/2024 1:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1518950484	5/6/2024 1:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		NC	5/6/2024 1:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144848003	5/6/2024 1:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		WV	5/6/2024 1:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1518950484	5/6/2024 1:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		WV	5/6/2024 1:57 PM
Details	Last Recertification Date	Update	Recertification	9/13/2022 3:21:22 PM	9/10/2023 12:17:36 PM	9/10/2023 12:17 PM
Addresses	Shipping Address	Update	Change Request	Carilion Rockbridge Community Hospital 1 Health Circle Lexington, VA 24450	Carilion Rockbridge Community Hospital 1 Health Circle Pharmacy Department Lexington, VA 24450	12/19/2022 6:58 AM
Addresses	Shipping Address	Delete	Group Change Request	Carilion Family Medicine Buchanan 18080 Main Street Buchanan, VA 24066		12/13/2022 3:49 PM
Addresses	Billing Address	Update	Group Change Request	Carilion Medical Center - Central Pharmacy Distribution 2823 Franklin Rd, SW BLDG A Roanoke, VA 24014	Carilion Rockbridge Community Hospital 1 Health Circle Lexington, VA 24450	12/13/2022 3:49 PM
Contacts	Authorizing Official	Update	AO Change Request	Madsen, Greg Todd VP Carilion Clinic 5404583590	Auwarter, Tim VP Hospital Operations Carilion Clinic 5409817804	11/10/2022 6:46 AM
Contacts	Authorizing Official	Update	Profile Change Request	Madsen, Greg Todd VP Carilion Clinic 5404983590	Madsen, Greg Todd VP Carilion Clinic 5404583590	10/17/2022 12:01 PM
Contacts	Signed By	Update	Profile Change Request	Madsen, Greg Todd VP Carilion Clinic 5404983590	Madsen, Greg Todd VP Carilion Clinic 5404583590	10/17/2022 12:01 PM
Addresses	Billing Address	Insert	Change Request		Carilion Medical Center - Central Pharmacy Distribution 2823 Franklin Rd, SW BLDG A Roanoke, VA 24014	9/20/2022 10:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1518950484	9/20/2022 10:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		VA	9/20/2022 10:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1144848003	9/20/2022 10:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		VA	9/20/2022 10:34 AM
Details	Last Recertification Date	Update	Recertification		9/13/2022 3:21:22 PM	9/13/2022 3:21 PM
Addresses	Main Address	Update	Change Request	18080 Main Street CC 08127230 Buchanan, VA 24066	18080 Main Street Buchanan, VA 24066	10/15/2021 9:53 AM
Addresses	Shipping Address	Insert	Change Request		Carilion Family Medicine Buchanan 18080 Main Street Buchanan, VA 24066	10/15/2021 9:53 AM
Addresses	Shipping Address	Insert	Change Request		Carilion Rockbridge Community Hospital 1 Health Circle Lexington, VA 24450	10/15/2021 9:53 AM
Addresses	Shipping Address	Insert	Change Request		Carilion Medical Center - Central Pharmacy Distribution 2823 Franklin Rd, SW Bldg A Roanoke, VA 24014	10/15/2021 9:53 AM
Details	State	Update		Approved	Active	10/1/2021 12:01 AM
Contacts	Signed By	Insert	New Registration		Madsen, Greg Todd VP Carilion Clinic 5404983590	8/5/2021 12:46 PM
Details	340B ID	Update	New Registration		CAH491304-04	8/5/2021 12:46 PM
Details	Entity Name	Update	New Registration	CARILION STONEWALL JACKSON HOSPITAL	CARILION ROCKBRIDGE COMMUNITY HOSPITAL	8/5/2021 12:46 PM
Details	Entity Subname	Update	New Registration	Carilion Family Medicine Buchanan	Carilion Family Medicine Buchanan - Carilion Family Medicine Buchanan	8/5/2021 12:46 PM
Dates	Participating Approval Date	Update	New Registration		8/5/2021 12:46:14 PM	8/5/2021 12:46 PM
Details	State	Update	New Registration	Pending	Approved	8/5/2021 12:46 PM
Dates	Signed By Date	Update	New Registration		8/4/2021 10:49:19 AM	8/5/2021 12:46 PM
Dates	Start Date	Update	New Registration		10/1/2021 12:00:00 AM	8/5/2021 12:46 PM
Addresses	Main Address	Insert	New Registration		18080 Main Street CC 08127230 Buchanan, VA 24066	7/14/2021 9:28 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/14/2021 9:28 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		491304	7/14/2021 9:28 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		VA	7/14/2021 9:28 AM
Contacts	Primary Contact	Insert	New Registration		Epperly, Trina 340B Program Director Carilion 5402243004	7/14/2021 9:28 AM
Contacts	Authorizing Official	Insert	New Registration		Madsen, Greg Todd VP Carilion Clinic 5404983590	7/14/2021 9:28 AM
Details	Assistance Received From Date	Insert	New Registration			7/14/2021 9:28 AM
Details	Assistance Received To Date	Insert	New Registration			7/14/2021 9:28 AM
Details	Last Recertification Date	Insert	New Registration			7/14/2021 9:28 AM
Details	Grant Number	Insert	New Registration			7/14/2021 9:28 AM
Details	340B ID	Insert	New Registration			7/14/2021 9:28 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/14/2021 9:28 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/14/2021 9:28 AM
Details	Medicare Provider Number	Insert	New Registration		491304	7/14/2021 9:28 AM
Details	Entity Name	Insert	New Registration		CARILION STONEWALL JACKSON HOSPITAL	7/14/2021 9:28 AM
Details	NOFO Number	Insert	New Registration			7/14/2021 9:28 AM
Details	Program Code	Insert	New Registration		CAH	7/14/2021 9:28 AM
Details	Entity Subname	Insert	New Registration		Carilion Family Medicine Buchanan	7/14/2021 9:28 AM
Dates	Participating Approval Date	Insert	New Registration			7/14/2021 9:28 AM
Details	State	Insert	New Registration		Pending	7/14/2021 9:28 AM
Dates	Registration Date	Insert	New Registration		7/14/2021 9:28:01 AM	7/14/2021 9:28 AM
Dates	Signed By Date	Insert	New Registration			7/14/2021 9:28 AM
Dates	Start Date	Insert	New Registration			7/14/2021 9:28 AM
Terminations	Termination Comments	Insert	New Registration			7/14/2021 9:28 AM
Terminations	Termination Date	Insert	New Registration			7/14/2021 9:28 AM
Terminations	Termination Effective Date	Insert	New Registration			7/14/2021 9:28 AM
Terminations	Termination Reason	Insert	New Registration			7/14/2021 9:28 AM