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NORTON COMMUNITY PHYSICIAN SERVICES,LLC
DSH490114B LONESOME PINE HOSPITAL
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Covered Entity Details
Entity Name
LONESOME PINE HOSPITAL
Subdivision Name
Ballad Health Cancer Care - A Department of Lonesome Pine Hospital
Type
Disproportionate Share Hospital
340B ID
DSH490114B
Entity Address
743 Island Road
Bristol, VA 24201
Medicare Provider Number
490114
Outpatient Facility Provider Number
Participating Start Date
1/1/2015
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
NORTON COMMUNITY PHYSICIAN SERVICES,LLC
Pharmacy Address
DBA BALLAD HEALTH PHARMACY
1490 PARK AVE NW STE 7
NORTON, VA 24273
Pharmacy Comments
03/08/2013 name change (was COMMUNITY HOSPITAL PHARMACY)
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shane Hilton, EVP, Chief Financial Officer
(423) 302-3467
Contract Pharmacy Representative
Balad Health
Steve Kilgore, SVP, Retail and Physician Services
(423) 915-5185
Signed By Date
1/15/2019
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