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DSH490024I CARILION MEDICAL CENTER (Terminated)
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Main Details
Name
CARILION MEDICAL CENTER
Subdivision Name
PRENATAL DIAGNOSTIC CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490024I
Medicare Provider Number
490024
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/4/2007
Participating Start Date
10/1/2007
Participating Approval Date
9/6/2007
Last Recertification Date
8/25/2015
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
Carilion Clinic
Tim Auwarter, VP Hospital Operations
(540) 981-7804
Primary Contact
Trina Epperly, 340B Program Manager
(540) 224-3004
Addresses
Street Address
102 HIGHLAND AVE SUITE 455
2210001
ROANOKE, VA 24013
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/10/2014 - Multiple terminations/reinstatements recorded in error; site remained continuously eligible from participation start date. 9/26/08 ADDED SHIP TO; 7/31/08 DOC RECD CONFIRM ELIG DSH ADJ %
04/14/2014
7/31/08 DOC RECD CONFIRM ELIG DSH ADJ %
08/05/2008
June 2025
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