340B Drug Pricing Program Database
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DSH440104HE Erlanger Health (Active)
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Main Details
Name
Erlanger Health
Subdivision Name
Erl Pr Care Dalton Walnut Ave - Primary Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH440104HE
Medicare Provider Number
440104
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/14/2021
Participating Start Date
4/1/2021
Participating Approval Date
2/10/2021
Last Recertification Date
9/9/2024
Contacts
Authorizing Official
Erlanger Health
Misty Brackett, VP Revenue Cycle
(423) 778-9775
Primary Contact
Erlanger Health System
Ngoc T. Le, 340B Program Coordinator
(423) 778-8194
Addresses
Street Address
1329 West Walnut Avenue
Suite 1 & 2
Dalton, GA 30720
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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