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NORTON COMMUNITY PHYSICIAN SERVICES,LLC
DSH490114 LONESOME PINE HOSPITAL
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Covered Entity Details
Entity Name
LONESOME PINE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490114
Entity Address
1990 HOLTON AVENUE EAST
BIG STONE GAP, VA 24219
Medicare Provider Number
490114
Participating Start Date
10/1/2006
Last Recertification Date
9/6/2024
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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