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DSH490009FX UNIVERSITY OF VIRGINIA MEDICAL CENTER (Active)
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Main Details
Name
UNIVERSITY OF VIRGINIA MEDICAL CENTER
Subdivision Name
Cancer Center Pantops Infusion - 2939 - Cancer Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH490009FX
Medicare Provider Number
490009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/13/2025
Participating Start Date
4/1/2025
Participating Approval Date
2/27/2025
Last Recertification Date
Contacts
Authorizing Official
UVA Health System
Brian Wilmoth, Strategic Planning and Reimbursement Officer
(434) 243-9802
Primary Contact
UVA Health
Mark D Vestal, Director, Pharmacy Supply Change & 340 B
(434) 924-9945
Addresses
Street Address
652 Peter Jefferson Parkway
310
Charlottesville, VA 22911
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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