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DSH490017M BON SECOURS MARYVIEW MEDICAL CENTER (Terminated)
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Main Details
Name
BON SECOURS MARYVIEW MEDICAL CENTER
Subdivision Name
Bon Secours Neuroscience Specialists
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490017M
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
8/27/2018
Termination Date
Termination Reason
10/1/2019
Hospital Outpatient facility no longer eligible
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
3640 High Street
Suite 1A
Portsmouth, VA 23707
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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2/12/2014 Non-printable characters removed from address.
02/12/2014
June 2025
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