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DSH490024DV CARILION MEDICAL CENTER (Terminated)
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Main Details
Name
CARILION MEDICAL CENTER
Subdivision Name
PEDS ADOL MED WF PSY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490024DV
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
For-Profit conversion
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
3649 Ferncliff Ave NW
1123835
Roanoke, VA 24017
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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