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ACCREDO HEALTH GROUP, INC.
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
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
2 BOULDEN CIR STE 1
NEW CASTLE, DE 19720-3492
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shane Hilton, EVP, Chief Financial Officer
(423) 302-3467
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500
Signed By Date
10/15/2020
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