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RRC440017-03 HOLSTON VALLEY HOSP & MED CTR (Terminated)
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Main Details
Name
HOLSTON VALLEY HOSP & MED CTR
Subdivision Name
Holston Valley Med Center Diagnostic Center / Cardiovascular Stress Testing
Type
Rural Referral Center
Rural
Yes
340B ID
RRC440017-03
Medicare Provider Number
440017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/10/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/14/2015
Last Recertification Date
8/18/2021
Termination Date
Termination Reason
4/1/2022
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
2050 Meadowview Parkway
Kingsport, TN 37660
Billing Address
Holston Valley Hosp & Med Center Pharmacy
P O BOX 659
Kingsport, TN 37660
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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