340B Drug Pricing Program Database
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DSH440050H TAKOMA REGIONAL HOSPITAL (Terminated)
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Main Details
Name
TAKOMA REGIONAL HOSPITAL
Subdivision Name
TAKOMA OUTPATIENT BEHAVIORAL HEALTH
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH440050H
Medicare Provider Number
440050
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2013
Participating Start Date
10/1/2013
Participating Approval Date
9/15/2013
Last Recertification Date
8/10/2016
Termination Date
Termination Reason
1/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
Ballad Health
Shane Hilton, EVP, Chief Financial Officer
(423) 302-3467
Primary Contact
Wellmont Health System
ALLAN SHARP, PHARMACIST
(423) 578-8541
Addresses
Street Address
303 Takoma Ave.
Greeneville, TN 37743
Billing Address
WELLMONT HEALTH SYSTEM
PO BOX 659
KINGSPORT, TN 37662
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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