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DSH440050L TAKOMA REGIONAL HOSPITAL (Terminated)
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Main Details
Name
TAKOMA REGIONAL HOSPITAL
Subdivision Name
Takoma Regional Hospital Sleep Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH440050L
Medicare Provider Number
440050
Outpatient Facility Provider Number
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
8/11/2015
Termination Date
Termination Reason
10/1/2015
Contacts
Authorizing Official
Ballad Health
Shane Hilton, EVP, Chief Financial Officer
(423) 302-3467
Primary Contact
Southeast Region
Diane Molnar, 340B Regional Manager
(828) 681-2168
Addresses
Street Address
1024 Coolidge Street
Greeneville, TN 37743
Billing Address
Takoma Regional Hospital
50 Hospital Dr.
Suite G - TAK
Hendersonville, NC 28792
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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