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RRC440017-00 HOLSTON VALLEY HOSP & MED CTR (Terminated)
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Main Details
Name
HOLSTON VALLEY HOSP & MED CTR
Subdivision Name
HOLSTON VALLEY HOSP & MED CTR
Type
Rural Referral Center
Rural
Yes
340B ID
RRC440017-00
Medicare Provider Number
440017
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2022
Participating Start Date
7/1/2022
Participating Approval Date
5/13/2022
Last Recertification Date
9/4/2024
Termination Date
Termination Reason
1/1/2025
DSH percentage below statutory minimum
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
130 W. RAVINE
KINGSPORT, TN 37662-0238
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (1/1/2015) until terminated effective date: (04/01/2022), reinstatement effective date: (07/01/2022)
05/13/2022
April 2025
April 2025
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