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DSH440104DX ERLANGER MEDICAL CENTER (Terminated)
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Main Details
Name
ERLANGER MEDICAL CENTER
Subdivision Name
WorkForce Clinic at VW Drive
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH440104DX
Medicare Provider Number
440104
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/5/2016
Participating Start Date
1/1/2017
Participating Approval Date
11/15/2016
Last Recertification Date
8/28/2018
Termination Date
Termination Reason
10/1/2018
Site closure
Contacts
Authorizing Official
Erlanger Health System
BRITTON J. TABOR, CFO
(423) 778-7729
Primary Contact
Erlanger Health System
Julia Friedman, 340B Program Coordinator
(423) 778-8194
Addresses
Street Address
7380 Volkswagen Drive Ste 100
Chattanooga, TN 37416
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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