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DSH490114B LONESOME PINE HOSPITAL (Active)
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Main Details
Name
LONESOME PINE HOSPITAL
Subdivision Name
Ballad Health Cancer Care - A Department of Lonesome Pine Hospital
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH490114B
Medicare Provider Number
490114
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/2/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/12/2014
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
Ballad Health
Shane Hilton, EVP, Chief Financial Officer
(423) 302-3467
Primary Contact
Ballad Health
Trish Tanner, VP, Chief Pharmacy Officer
(423) 302-3532
Addresses
Street Address
743 Island Road
Bristol, VA 24201
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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