340B Drug Pricing Program Database
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DSH490017A Maryview Hospital LLC (Active)
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Main Details
Name
Maryview Hospital LLC
Subdivision Name
OUTPATIENT INFUSION CENTER AT HARBO
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490017A
Medicare Provider Number
490017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
3/4/2010
Participating Start Date
4/1/2010
Participating Approval Date
3/10/2010
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
Bon Secours Mercy Health
Jonathan Lee Haynes, Hampton Roads Market CFO
(540) 270-2809
Primary Contact
Bon Secours Mercy Health
Diana Willman, Pharmacy Director
(757) 398-2192
Addresses
Street Address
7185 Harbour Towne Pkwy S
Ste 107
Suffolk, VA 23435
Billing Address
Bon Secours Maryview Medical Center
3636 High St
Portsmouth, VA 23707
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/30/2009 DOC. RECD. TO CONFIRM DSH ADJ
03/26/2010
June 2025
June 2025
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