340B Drug Pricing Program Database
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DSH490024CH CARILION MEDICAL CENTER (Terminated)
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Main Details
Name
CARILION MEDICAL CENTER
Subdivision Name
CCMOB PM & REHAB/SPINE CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490024CH
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
12/3/2017
Termination Date
Termination Reason
7/1/2018
Other
Contacts
Authorizing Official
Carilion Clinic
Tim Auwarter, VP Hospital Operations
(540) 981-7804
Primary Contact
Carilion
Trina Epperly, 340B Program Director
(540) 224-3004
Addresses
Street Address
3 RIVERSIDE CIRCLE
1125084
ROANOKE, VA 24016
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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