340B Drug Pricing Program Database
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DSH490024DG CARILION MEDICAL CENTER (Terminated)
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Main Details
Name
CARILION MEDICAL CENTER
Subdivision Name
ORTHO SPINE CNRV
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490024DG
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
9/5/2016
Termination Date
Termination Reason
10/1/2016
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
2900 Lamb Cr Ste 380
1123566
Christiansburg, VA 24073
Billing Address
Carilion Medical Center- Central Pharmacy Distribution
2823 Franklin Rd
Roanoke, VA 24014
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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