340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
CARILION CLINIC PHARMACY ROANOKE MEMORIA
DSH490024 CARILION MEDICAL CENTER
Print
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 ROANOKE MEMORIA
Pharmacy Address
1906 BELLEVIEW AVE SE
ROANOKE, VA 24014-1838
Pharmacy Comments
Contract Details
Approval Date
11/16/2011
Contract Begin Date
11/30/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donald Lorton, CFO
(540) 981-7400
Contract Pharmacy Representative
Verne Baker, VP - Pharmacy
(540) 981-7786
Signed By Date
11/14/2011
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session