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RRC440017-08 HOLSTON VALLEY HOSP & MED CTR (Terminated)
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Main Details
Name
HOLSTON VALLEY HOSP & MED CTR
Subdivision Name
WELLMONT CANCER INSTITUTE ALLANDALE / INFUSION SERVICES
Type
Rural Referral Center
Rural
Yes
340B ID
RRC440017-08
Medicare Provider Number
440017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/6/2017
Participating Start Date
4/1/2017
Participating Approval Date
1/10/2017
Last Recertification Date
9/10/2018
Termination Date
Termination Reason
10/1/2019
Site closure
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
4485 WEST STONE DRIVE
SUITE 200B
KINGSPORT, TN 37660
Billing Address
WELLMONT HEALTH SYSTEM
PO BOX 659
KINGSPORT, TN 37662
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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