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CAH491303-00 DICKENSON COMMUNITY HOSPITAL (Active)
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Main Details
Name
DICKENSON COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
Rural
No
340B ID
CAH491303-00
Medicare Provider Number
491303
Additional Details
Current Program Status
Active
Registration Date
7/11/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/18/2017
Last Recertification Date
9/4/2024
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
312 HOSPITAL DRIVE
CLINTWOOD, VA 24228-0000
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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