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DSH490017L BON SECOURS MARYVIEW MEDICAL CENTER (Terminated)
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Main Details
Name
BON SECOURS MARYVIEW MEDICAL CENTER
Subdivision Name
Outpatient Infusion Center-Chesapeake
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490017L
Medicare Provider Number
490017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2013
Participating Start Date
4/1/2013
Participating Approval Date
3/11/2013
Last Recertification Date
9/4/2019
Termination Date
Termination Reason
10/1/2020
Site closure
Contacts
Authorizing Official
MaryView Medical Center
John Carr Simmerman, CFO
(757) 398-2133
Primary Contact
Bon Secours
Coley W Deal, 340B Program Manager
(804) 221-4837
Addresses
Street Address
612 Kingsborough Square
Suite 300
Chesapeake, VA 23320
Billing Address
Bon Secours Maryview Medical Center
3636 High Street
Portsmouth, VA 23707
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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