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DSH490024ER CARILION MEDICAL CENTER (Active)
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Main Details
Name
CARILION MEDICAL CENTER
Subdivision Name
Carilion Adolescent Medicine Clinic - Carilion Adolescent Medicine Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490024ER
Medicare Provider Number
490024
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/24/2017
Participating Start Date
1/1/2018
Participating Approval Date
10/31/2017
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
Carilion Clinic
Tim Auwarter, VP Hospital Operations
(540) 981-7804
Primary Contact
Carilion
Trina Epperly, 340B Program Director
(540) 224-3004
Addresses
Street Address
4348 Electric Rd., Mall Interior 2nd Floor Ent. 4
Roanoke, VA 24018
Billing Address
Carilion Roanoke Memorial Hospital
1906 Belleview Ave SE
Roanoke, VA 24014
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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