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DSH440063A JOHNSON CITY MEDICAL CENTER (Active)
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Main Details
Name
JOHNSON CITY MEDICAL CENTER
Subdivision Name
Ballad Health Cancer Care a Department of Johnson City Medical Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH440063A
Medicare Provider Number
440063
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
5/4/2010
Participating Start Date
7/1/2010
Participating Approval Date
6/18/2010
Last Recertification Date
9/4/2024
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
1 PROFESSIONAL PARK DRIVE
SUITE 21
JOHNSON CITY, TN 37604
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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