340B Drug Pricing Program Database
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DSH440104BX ERLANGER MEDICAL CENTER (Terminated)
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Main Details
Name
ERLANGER MEDICAL CENTER
Subdivision Name
EN Multi-Specialty
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH440104BX
Medicare Provider Number
440104
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/4/2016
Participating Start Date
1/1/2017
Participating Approval Date
11/3/2016
Last Recertification Date
8/28/2018
Termination Date
Termination Reason
10/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
Erlanger Health System
BRITTON J. TABOR, CFO
(423) 778-7729
Primary Contact
Erlanger Health System
Ngoc T. Le, 340B Program Coordinator
(423) 778-8194
Addresses
Street Address
632 Morrison Springs Road
Suite 202
Chattanooga, TN 37415
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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