340B Drug Pricing Program Database
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DSH490017E BON SECOURS MARYVIEW MEDICAL CENTER (Terminated)
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Main Details
Name
BON SECOURS MARYVIEW MEDICAL CENTER
Subdivision Name
Nansemond Suffolk Family Practice
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490017E
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
8/23/2021
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
MaryView Medical Center
John Carr Simmerman, CFO
(757) 398-2133
Primary Contact
Bon Secours
Danielle Bouldin, Director of Pharmacy
(757) 398-2192
Addresses
Street Address
2897 Bridge Road
Suffolk, VA 23435
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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