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DSH490052C RIVERSIDE REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
RIVERSIDE REGIONAL MEDICAL CENTER
Subdivision Name
Riverside Orthopedic, Sports Medicine and Physiatry Specialists
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490052C
Medicare Provider Number
490052
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/4/2008
Participating Start Date
9/4/2008
Participating Approval Date
9/4/2008
Last Recertification Date
11/30/2017
Termination Date
Termination Reason
4/1/2018
Other
Contacts
Authorizing Official
Riverside Healthcare Association Inc
WILLIAM W. AUSTIN JR., SENIOR VP & CFO
(757) 534-7015
Primary Contact
Riverside Health System
Cynthia Williams, VP/Chief Pharmacy Officer
(757) 784-1569
Addresses
Street Address
12420 WARWICK BOULEVARD
BUILDING 3, SUITE C
NEWPORT NEWS, VA 23606
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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