340B Drug Pricing Program Database
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DSH490017C BON SECOURS MARYVIEW MEDICAL CENTER (Terminated)
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Main Details
Name
BON SECOURS MARYVIEW MEDICAL CENTER
Subdivision Name
Internists at Western Branch
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490017C
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
8/26/2016
Termination Date
Termination Reason
1/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
MaryView Medical Center
John Carr Simmerman, CFO
(757) 398-2133
Primary Contact
Bon Secours Health System
Coley Deal, Bon Secours 340B Manager
(804) 221-4837
Addresses
Street Address
4020 Raintree Road
Suite B
Chesapeake, VA 23321
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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