340B Drug Pricing Program Database
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DSH490024BT CARILION MEDICAL CENTER (Terminated)
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Main Details
Name
CARILION MEDICAL CENTER
Subdivision Name
PEDS INFECTIOUS DISEASE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490024BT
Medicare Provider Number
490024
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/4/2014
Participating Start Date
7/1/2014
Participating Approval Date
6/2/2014
Last Recertification Date
8/25/2015
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
Carilion Clinic
Tim Auwarter, VP Hospital Operations
(540) 981-7804
Primary Contact
Trina Epperly, 340B Program Manager
(540) 224-3004
Addresses
Street Address
1906 BELLEVIEW AVE
1123755
ROANOKE, VA 24014
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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