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DSH490017G BON SECOURS MARYVIEW MEDICAL CENTER (Terminated)
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Main Details
Name
BON SECOURS MARYVIEW MEDICAL CENTER
Subdivision Name
Western Branch Primary Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490017G
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
8/24/2023
Termination Date
Termination Reason
7/1/2024
Hospital Outpatient facility no longer eligible
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
2613 Taylor Road
Suite 201
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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