A gold color metal and enamel device 1 1/8 inches (2.86 cm) in height overall consisting of a maroon cross bearing a scarlet disk with a white border, all in front of gold rays issuing from the cross and above a group of five scarlet peaks in base, the sides of the cross and base of the peaks all enclosed by two green branches, olive on the left and oak on the right, terminating at the top on each side of a gold arched scroll inscribed "SAVE," and the base of the branches extending below the center of a gold curved scroll inscribed "STRENGTHEN SUPPORT," all letters maroon.
Maroon and white are colors used for the Army Medical Department. Scarlet refers to the predecessor hospital's Meritorious Unit Commendation for service in Italy during World War II. The peaks, indicating mountainous terrain of the North Apennines and Po Valley, denote the area where the unit was cited; the olive spray alludes to the operation code name "Olive." Additionally, the wreath of olive and oak, suggested by the coat of arms of Italy, and the five peaks represent the hospital's participation in five campaigns. Both the cross, a symbol of aid and assistance, and the gold rays which signify radiant healing capabilities, refer to the unit's mission. The scarlet disk with white border, from the flag of Ohio, indicates the hospital's location.
The distinctive unit insignia was originally approved for the 256th General Hospital on 3 February 1971. It was redesignated on 6 July 1994, for the 256th Combat Support Hospital with the description and symbolism revised.