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ELIXIR PHARMACY, LLC
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
ELIXIR PHARMACY, LLC
Pharmacy Address
7835 FREEDOM AVE NW
NORTH CANTON, OH 44720
Pharmacy Comments
Contract Details
Approval Date
4/17/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tim Auwarter, VP Hospital Operations
(540) 981-7804
Contract Pharmacy Representative
Elixir Pharmacy LLC
Bill Trexler, Vice President Finance
(877) 437-9012
Signed By Date
4/17/2023
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