Covered Entity Details

DSH490094 RICHMOND COMMUNITY HOSPITAL (Active) - information as of 6/16/2025 11:22:22 PM

Main Details

Name

RICHMOND COMMUNITY HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH490094

Medicare Provider Number

490094

Additional Details

Current Program Status

Active

Registration Date

6/5/2006

Participating Start Date

1/1/2004

Participating Approval Date

6/5/2006

Last Recertification Date

8/21/2024

Contacts

Authorizing Official

Bon Secours Mercy Health
Gregory S Simmons, Site CFO
(804) 248-8731

Primary Contact

Richmond Community Hospital
DeJuan Branch, Director of Pharmacy
(804) 343-6407

Addresses

Street Address

1500 North 28TH Street
RICHMOND, VA 23223

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
3/27/12 REVISED MEDICAID # (WAS 004900944); 6/5/06 - REPLACES DSH23223	03/27/2012
6/5/06 - REPLACES DSH23223	01/04/2007

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
VA	490094	1366404428,1841787868

Shipping Addresses

Shipping Address 1

RICHMOND COMMUNITY HOSP PHAR
1500 N 28TH ST
Richmond, VA 23223

Shipping Address 2

Southside OPIC Pharmacy
14051 St Francis Blvd
STE 1400
Midlothian, VA 23114

Shipping Address 3

Bon Secours-Richmond Community Hospital DBA Hanover OPIC Pharmacy
8262 Atlee Rd
MOB III Suite 200
Mechanicsville, VA 23116

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	08/08/2019	10/01/2019		02/14/2025
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	08/08/2019	10/01/2019	10/01/2024	11/05/2024
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	08/08/2019	10/01/2019	10/01/2024	11/05/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	08/08/2019	10/01/2019	07/11/2023	07/11/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	08/08/2019	10/01/2019		02/14/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	08/08/2019	10/01/2019		02/14/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	01/14/2022	04/01/2022		02/14/2025
Contract Detail	ACRO PHARMACEUTICAL SERVICES LLC	ACRO PHARMACEUTICAL SERVICES LLC	313 HENDERSON DR	SHARON HILL	PA	19079	01/16/2019	04/01/2019	07/17/2019	08/15/2019
Contract Detail	BON SECOURS - VIRGINIA HEALTHSOURCE INC	DBA HARNESS HEALTH PHARMACY #502	6900 FOREST AVE STE 100	RICHMOND	VA	23230	10/15/2018	01/01/2019	11/07/2024	11/14/2024
Contract Detail	BON SECOURS - VIRGINIA HEALTHSOURCE INC.	BON SECOURS GOOD HEALTH PHARMACY AT RICH	1510 N 28TH ST STE 100	RICHMOND	VA	23223	07/18/2014	10/01/2014		04/14/2025
Contract Detail	COMMCARE PHARMACY-FTL, LLC	855 SW 78TH AVE STE C100		PLANTATION	FL	33324-3223	10/15/2018	01/01/2019	07/17/2019	08/15/2019
Contract Detail	GOOD HEALTH PHARMACY AT HANOVER	8200 MEADOWBRIDGE RD STE 301		MECHANICSVILLE	VA	23116-2337	01/26/2017	04/01/2017	09/18/2020	09/18/2020
Contract Detail	HARNESS HEALTH PHARMACY	7160 INDUSTRIAL ROW DR	SUITE 330	MASON	OH	45040	01/16/2019	04/01/2019	11/07/2024	11/14/2024
Contract Detail	HARNESS HEALTH PHARMACY	7160 INDUSTRIAL ROW DR STE 331		MASON	OH	45040	01/14/2020	04/01/2020	11/07/2024	11/14/2024
Contract Detail	HARNESS HEALTH PHARMACY-CENTRAL PHARMACY	DBA HARNESS HEALTH PHARMACY #330	7160 INDUSTRIAL ROW DR STE 330	MASON	OH	45040	11/05/2024	11/07/2024		11/14/2024
Contract Detail	HARNESS HEALTH PHARMACY-CENTRAL PHARMACY	DBA HARNESS HEALTH PHARMACY #331	7160 INDUSTRIAL ROW DR STE 331	MASON	OH	45040	11/05/2024	11/07/2024		11/14/2024
Contract Detail	HARNESS HEALTH PHARMACY-CENTRAL PHARMACY	DBA HARNESS HEALTH PHARMACY #502	6900 FOREST AVE STE 100	RICHMOND	VA	23230	11/05/2024	11/07/2024		11/14/2024
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	04/14/2025	07/01/2025		04/14/2025
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	04/14/2025	07/01/2025		04/14/2025

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH490094A	Child	DSH	RICHMOND COMMUNITY HOSPITAL	Bremo Outpatient Infusion Center SO	5875 BREMO RD	RICHMOND	VA	Active
DSH490094B	Child	DSH	RICHMOND COMMUNITY HOSPITAL	Hanover Outpatient Infusion Center	8262 Atlee Rd	MECHANICSVILLE	VA	Active
DSH490094C	Child	DSH	RICHMOND COMMUNITY HOSPITAL	Midlothian Outpatient Infusion Cent - Outpatient Infusion	14051 St Francis Blvd	Midlothian	VA	Active
DSH490094D	Child	DSH	RICHMOND COMMUNITY HOSPITAL	Bremo Outpatient Infusion Center NO - Pediatric	5855 Bremo Rd	Richmond	VA	Active
DSH490094E	Child	DSH	RICHMOND COMMUNITY HOSPITAL	Richmond Community Hosp-OP Infusion	1510 N 28th St	Richmond	VA	Active
DSH490094F	Child	DSH	RICHMOND COMMUNITY HOSPITAL	Bon Secours Cancer Institute St Mar - Medical Oncology	5875 Bremo Road	Richmond	VA	Active
DSH490094G	Child	DSH	RICHMOND COMMUNITY HOSPITAL	Bon Secours Liver Institute of RICH	5855 Bremo Rd	Richmond	VA	Active
DSH490094H	Child	DSH	RICHMOND COMMUNITY HOSPITAL	BS Cancer Institute Med Oncology	8262 Atlee Road	Mechanicsville	VA	Active
DSH490094J	Child	DSH	RICHMOND COMMUNITY HOSPITAL	Bon Secours Cancer Institute St Fra - Medical Oncology	14051 St. Francis Boulevard	Midlothian	VA	Active
DSH490094K	Child	DSH	RICHMOND COMMUNITY HOSPITAL	Bon Secours Commonwealth Gynecologi	5875 Bremo Rd	Richmond	VA	Active
DSH490094L	Child	DSH	RICHMOND COMMUNITY HOSPITAL	BON SECOURS RHEUMATOLOGY CENTER - Rheumatology	9602 PATTERSON AVE	RICHMOND	VA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Main Address	Update	Change Request	1500 N 28TH ST RICHMOND, VA 23223	1500 North 28TH Street RICHMOND, VA 23223	2/20/2025 7:40 AM
Addresses	Shipping Address	Update	Change Request	Bon Secours Richmond Community Hospital 1500 N. 28th Street Richmond, VA 23223	RICHMOND COMMUNITY HOSP PHAR 1500 N 28TH ST Richmond, VA 23223	12/10/2024 7:23 AM
Addresses	Shipping Address	Update	Change Request	Bon Secours Richmond Community Outpatient Infusion Center-Southside 14051 Saint Francis Blvd Suite 1400 Midlothian, VA 23114	Southside OPIC Pharmacy 14051 St Francis Blvd STE 1400 Midlothian, VA 23114	12/10/2024 7:23 AM
Details	Entity Name	Update	Change Request	BON SECOURS RICHMOND COMMUNITY HOSPITAL	RICHMOND COMMUNITY HOSPITAL	12/10/2024 7:23 AM
Details	Last Recertification Date	Update	Recertification	8/22/2023 11:29:37 AM	8/21/2024 11:11:07 AM	8/21/2024 11:11 AM
Addresses	Shipping Address	Insert	Change Request		Bon Secours-Richmond Community Hospital DBA Hanover OPIC Pharmacy 8262 Atlee Rd MOB III Suite 200 Mechanicsville, VA 23116	4/15/2024 7:54 AM
Details	Last Recertification Date	Update	Recertification	8/31/2022 3:44:42 PM	8/22/2023 11:29:37 AM	8/22/2023 11:29 AM
Contacts	Authorizing Official	Update	AO Change Request	Kusnierz, William Joseph CFO - Richmond Market Bon Secours Mercy Health 5132628762	Simmons, Gregory S Site CFO Bon Secours Mercy Health 8042488731	7/24/2023 7:24 AM
Contacts	Authorizing Official	Update	Profile Change Request	Kusnierz, William Joseph Market CFO Community Mercy Health Partners 9375235512	Kusnierz, William Joseph CFO - Richmond Market Bon Secours Mercy Health 5132628762	6/13/2023 2:01 PM
Contacts	Authorizing Official	Update	AO Change Request	Giorgiani, Ryan CFO Bon Secours Mercy Health 8044538864	Kusnierz, William Joseph Market CFO Community Mercy Health Partners 9375235512	4/26/2023 10:09 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1841787868	12/1/2022 7:38 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	12/1/2022 7:38 AM
Details	Last Recertification Date	Update	Recertification	8/30/2021 11:19:57 AM	8/31/2022 3:44:42 PM	8/31/2022 3:44 PM
Contacts	Authorizing Official	Update	AO Change Request	Haynes, Jonathan Lee Site CFO III Bon Secours Mercy Health 8042818548	Giorgiani, Ryan CFO Bon Secours Mercy Health 8044538864	1/21/2022 12:18 PM
Details	Last Recertification Date	Update	Recertification	8/25/2020 10:37:42 AM	8/30/2021 11:19:57 AM	8/30/2021 11:19 AM
Contacts	Authorizing Official	Update	Profile Change Request	Haynes, Jonathan Lee Site CFO III Bon Secours Mercy Health 8045947408	Haynes, Jonathan Lee Site CFO III Bon Secours Mercy Health 8042818548	7/7/2021 2:08 PM
Contacts	Primary Contact	Update	Change Request	Hancock, Karen Executive Director of Pharmacy Bon Secours Mercy Health 7277299003	Branch, DeJuan Director of Pharmacy Richmond Community Hospital 8043436407	5/21/2021 10:01 AM
Contacts	Primary Contact	Update	Change Request	Cavanaugh, Margaret Pharmacy Operations Manager Bon Secours 8043436407	Hancock, Karen Executive Director of Pharmacy Bon Secours Mercy Health 7277299003	3/4/2021 12:11 PM
Contacts	Authorizing Official	Update	Change Request	Simmons, Gregory S Site CFO Bon Secours Mercy Health 8047646629	Haynes, Jonathan Lee Site CFO III Bon Secours Mercy Health 8045947408	3/2/2021 8:02 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1366404428	8/25/2020 10:37 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	8/25/2020 10:37 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1366404428 ( )		8/25/2020 10:37 AM
Details	Last Recertification Date	Update	Recertification	9/9/2019 8:43:05 AM	8/25/2020 10:37:42 AM	8/25/2020 10:37 AM
Contacts	Authorizing Official	Update	AO Change Request	Quiriconi, Stephan Senior VP of Finance Bon Secours Mercy Health System 8042818301	Simmons, Gregory S Site CFO Bon Secours Mercy Health 8047646629	6/25/2020 6:55 AM
Contacts	Primary Contact	Update	Change Request	Deal, Coley W 340B Program Manager Bon Secours 8042214837	Cavanaugh, Margaret Pharmacy Operations Manager Bon Secours 8043436407	3/25/2020 12:06 PM
Details	Last Recertification Date	Update	Recertification	8/22/2018 4:42:30 PM	9/9/2019 8:43:05 AM	9/9/2019 8:43 AM
Contacts	Authorizing Official	Update	Change Request	Bartlett, Cindy K. VP Corporate Responsibility Bon Secours Health System 7576735835	Quiriconi, Stephan Senior VP of Finance Bon Secours Mercy Health System 8042818301	12/17/2018 9:06 AM
Addresses	Shipping Address	Insert	Recertification		Bon Secours Richmond Community Hospital 1500 N. 28th Street Richmond, VA 23223	8/22/2018 4:42 PM
Addresses	Shipping Address	Insert	Recertification		Bon Secours Richmond Community Outpatient Infusion Center-Southside 14051 Saint Francis Blvd Suite 1400 Midlothian, VA 23114	8/22/2018 4:42 PM
Details	Last Recertification Date	Update	Recertification	12/5/2017 2:39:44 PM	8/22/2018 4:42:30 PM	8/22/2018 4:42 PM
Contacts	Authorizing Official	Update	AO Change Request	Gordon, Mark CEO Bon Secours 8047646102	Bartlett, Cindy K. VP Corporate Responsibility Bon Secours Health System 7576735835	8/22/2018 7:16 AM
Contacts	Primary Contact	Update	Recertification	Powell, James Patrick Pharmacy Operations Manager 8042251711	Deal, Coley W 340B Program Manager Bon Secours 8042214837	12/5/2017 2:39 PM
Details	Last Recertification Date	Update	Recertification	8/26/2016 12:00:00 AM	12/5/2017 2:39:44 PM	12/5/2017 2:39 PM
Contacts	Authorizing Official	Update		Gordon, Mark CEO 8047646102	Gordon, Mark CEO Bon Secours 8047646102	12/5/2017 2:26 PM
Contacts	Authorizing Official	Update		ROBINSON, MICHAEL CHIEF EXECUTIVE OFFICER 8047646102	Gordon, Mark CEO 8047646102	2/16/2017 4:02 PM
Contacts	Primary Contact	Update		McNeely, Michael Finance Executive 8047646629	Powell, James Patrick Pharmacy Operations Manager 8042251711	2/15/2017 2:45 PM
Addresses	Main Address	Insert			1500 N 28TH ST RICHMOND, VA 23223	2/15/2017 2:44 PM
Details	Last Recertification Date	Update		8/20/2015 12:00:00 AM	8/26/2016 12:00:00 AM	8/26/2016 4:02 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/20/2015 9:16 AM
Details	Last Recertification Date	Update		8/19/2014 12:00:00 AM	8/20/2015 12:00:00 AM	8/20/2015 9:16 AM
Medicaid Billing	Medicaid: Number	Update		004900944	490094	6/4/2015 7:45 AM
Medicaid Billing	NPI: Number	Insert			1366404428	6/4/2015 7:45 AM
Contacts	Primary Contact	Update		MCNEELY, MIKE ADMIN DIRECTOR OF FINANCE 8047646629	McNeely, Michael Finance Executive 8047646629	8/19/2014 11:50 AM
Details	Last Recertification Date	Update		8/23/2013 12:00:00 AM	8/19/2014 12:00:00 AM	8/19/2014 11:49 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/23/2013 12:00:00 AM	8/23/2013 1:37 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/17/2012 9:07 AM
Contacts	Primary Contact	Insert			MCNEELY, MIKE ADMIN DIRECTOR OF FINANCE 8047646629	3/27/2012 4:46 PM
Contacts	Authorizing Official	Insert			ROBINSON, MICHAEL CHIEF EXECUTIVE OFFICER 8047646102	3/27/2012 4:46 PM
Details	Comments Public	Insert			3/27/12 REVISED MEDICAID # (WAS 004900944); 6/5/06 - REPLACES DSH23223	3/27/2012 4:46 PM
Details	Last Recertification Date	Insert				1/4/2007 8:46 AM
Details	Grant Number	Insert				1/4/2007 8:46 AM
Details	340B ID	Insert			DSH490094	1/4/2007 8:46 AM
Details	Is Authorizing Official EHB Data	Insert				1/4/2007 8:46 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/4/2007 8:46 AM
Details	Medicare Provider Number	Insert			490094	1/4/2007 8:46 AM
Details	Entity Name	Insert			BON SECOURS RICHMOND COMMUNITY HOSPITAL	1/4/2007 8:46 AM
Details	Program Code	Insert			DSH	1/4/2007 8:46 AM
Details	Entity Subname	Insert				1/4/2007 8:46 AM
Dates	Participating Approval Date	Insert			6/5/2006 12:00:00 AM	1/4/2007 8:46 AM
Details	State	Insert			Active	1/4/2007 8:46 AM
Dates	Registration Date	Insert			6/5/2006 12:00:00 AM	1/4/2007 8:46 AM
Dates	Signed By Date	Insert				1/4/2007 8:46 AM
Dates	Start Date	Insert			1/1/2004 12:00:00 AM	1/4/2007 8:46 AM
Terminations	Termination Comments	Insert				1/4/2007 8:46 AM
Terminations	Termination Date	Insert				1/4/2007 8:46 AM
Terminations	Termination Effective Date	Insert				1/4/2007 8:46 AM
Terminations	Termination Reason	Insert				1/4/2007 8:46 AM
Details	Comments Public	Insert			6/5/06 - REPLACES DSH23223	1/4/2007 8:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert			True	6/5/2006 7:27 AM
Medicaid Billing	Medicaid: Number	Insert			004900944	6/5/2006 7:27 AM
Medicaid Billing	Medicaid: State	Insert			VA	6/5/2006 7:27 AM