340B Drug Pricing Program Database
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DSH490022S MARY WASHINGTON HOSPITAL (Terminated)
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Main Details
Name
MARY WASHINGTON HOSPITAL
Subdivision Name
MWH Trauma - Trauma Surgery
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490022S
Medicare Provider Number
490022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2024
Participating Start Date
7/1/2024
Participating Approval Date
6/11/2024
Last Recertification Date
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Mary Washington Healthcare
Sean Timothy Barden, Executive VP & CFO
(540) 741-1494
Primary Contact
Mary Washington Hospital
John Michael Coggins, Director of Pharmacy
(540) 741-7525
Addresses
Street Address
1101 Sam Perry Blvd, Suite 221
Fredericksburg, VA 22401
Billing Address
Mary Washington Hospital
2300 Fall Hill Avenue
Suite 313
Fredericksburg, VA 22401
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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