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DSH490024CV CARILION MEDICAL CENTER (Terminated)
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Main Details
Name
CARILION MEDICAL CENTER
Subdivision Name
CARDIOLOGY LIPID
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490024CV
Medicare Provider Number
490024
Outpatient Facility Provider Number
490024
Additional Details
Current Program Status
Terminated
Registration Date
7/9/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/3/2014
Last Recertification Date
9/10/2018
Termination Date
Termination Reason
10/1/2019
Hospital Outpatient facility no longer eligible
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
2001 Crystal Spring Ave, STE 300
1123347
Roanoke, VA 24014
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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