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DSH440063 JOHNSON CITY MEDICAL CENTER (Active)
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Main Details
Name
JOHNSON CITY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH440063
Medicare Provider Number
440063
Additional Details
Current Program Status
Active
Registration Date
7/1/2005
Participating Start Date
7/1/2005
Participating Approval Date
6/3/2005
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Ballad Health
Shane Hilton, EVP, Chief Financial Officer
(423) 302-3467
Primary Contact
Ballad Health
Trish Tanner, VP, Chief Pharmacy Officer
(423) 302-3532
Addresses
Street Address
400 N. STATE OF FRANKLIN RD.
JOHNSON CITY, TN 37604-6094
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/17/09 ADDED NPI AND MEDICAID#
04/17/2009
April 2025
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