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DSH490024Y CARILION MEDICAL CENTER (Terminated)
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Main Details
Name
CARILION MEDICAL CENTER
Subdivision Name
INTENSIVISTS / CARILION ROANOKE MEMORIAL HOSPITAL
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490024Y
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
1906 BELLEVIEW AVE.
1123405
ROANOKE, VA 24014
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
April 2025
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