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CARILION CLINIC PHARMACY SALEM
DSH490024 CARILION MEDICAL CENTER
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Covered Entity Details
Entity Name
CARILION MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490024
Entity Address
1906 BELLEVIEW AVE SE
ROANOKE, VA 24014
Medicare Provider Number
490024
Participating Start Date
10/1/2007
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
CARILION CLINIC PHARMACY SALEM
Pharmacy Address
3737 W. MAIN ST
STE 106
SALEM, VA 24153
Pharmacy Comments
Contract Details
Approval Date
10/24/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Tim Auwarter, VP Hospital Operations
(540) 981-7804
Contract Pharmacy Representative
Carilion Clinic
Chad Alvarez, Retail Pharmac Systems Director
(540) 510-4772
Signed By Date
10/24/2019
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