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DSH490022M MARY WASHINGTON HOSPITAL (Active)
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Main Details
Name
MARY WASHINGTON HOSPITAL
Subdivision Name
MARY WASHINGTON HOSPITAL - MWH OP INFUSION
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490022M
Medicare Provider Number
490022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/11/2024
Participating Start Date
7/1/2024
Participating Approval Date
6/11/2024
Last Recertification Date
8/15/2024
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
405 Chatham Heights Rd
FREDERICKSBURG, VA 22405
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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