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DSH490024AL CARILION MEDICAL CENTER (Active)
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Main Details
Name
CARILION MEDICAL CENTER
Subdivision Name
BREAST SURGERY CCR3
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490024AL
Medicare Provider Number
490024
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
9/4/2007
Participating Start Date
10/1/2007
Participating Approval Date
9/6/2007
Last Recertification Date
9/4/2024
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
3 RIVERSIDE CIRCLE
ROANOKE, VA 24016
Billing Address
Carilion Roanoke Memorial Hospital
1906 Belleview Ave SE
Roanoke, VA 24014
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
April 2025
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