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DSH490114A LONESOME PINE HOSPITAL (Active)
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Main Details
Name
LONESOME PINE HOSPITAL
Subdivision Name
Ballad Health Cancer Care - A Department of Lonesome Pine Hospital
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH490114A
Medicare Provider Number
490114
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/27/2011
Participating Start Date
4/1/2011
Participating Approval Date
2/10/2011
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
671 HIGHWAY 58 East
NORTON, VA 24273
Billing Address
Ballad Health
Lonesome Pine Hospital
400 North State of Franklin Drive
Johnson City, TN 37604
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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6/07 - DSH ADJ % >11.75
02/10/2011
April 2025
April 2025
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