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DSH440104EL ERLANGER MEDICAL CENTER (Terminated)
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Main Details
Name
ERLANGER MEDICAL CENTER
Subdivision Name
General Pediatrics - General Pediatrics East
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH440104EL
Medicare Provider Number
440104
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/5/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/13/2018
Last Recertification Date
9/11/2019
Termination Date
Termination Reason
10/1/2020
Other
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
1755 Gunbarrel Rd
Suite 206
Chattanooga, TN 37421
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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