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CAH441304-00 JOHNSON COUNTY COMMUNITY HOSPITAL (Active)
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Main Details
Name
JOHNSON COUNTY COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH441304-00
Medicare Provider Number
441304
Additional Details
Current Program Status
Active
Registration Date
7/13/2018
Participating Start Date
10/1/2018
Participating Approval Date
7/31/2018
Last Recertification Date
9/6/2024
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
1901 SOUTH SHADY STREET
MOUNTAIN CITY, TN 37683
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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