340B Drug Pricing Program Database
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DSH490024DA CARILION MEDICAL CENTER (Terminated)
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Main Details
Name
CARILION MEDICAL CENTER
Subdivision Name
PEDS ID ROANOKE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490024DA
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
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
101 Elm Avenue, S.E.
1123375
Roanoke, VA 24016
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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