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DSH440050M TAKOMA REGIONAL HOSPITAL (Terminated)
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Main Details
Name
TAKOMA REGIONAL HOSPITAL
Subdivision Name
Takoma Regional Hospital Center for Rehabilitation
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH440050M
Medicare Provider Number
440050
Outpatient Facility Provider Number
440050
Additional Details
Current Program Status
Terminated
Registration Date
1/6/2014
Participating Start Date
4/1/2014
Participating Approval Date
2/12/2014
Last Recertification Date
8/10/2016
Termination Date
Termination Reason
1/1/2018
Hospital Outpatient facility no longer eligible
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
108 West Summer Street
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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