340B Drug Pricing Program Database
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DSH490017W BON SECOURS MARYVIEW MEDICAL CENTER (Terminated)
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Main Details
Name
BON SECOURS MARYVIEW MEDICAL CENTER
Subdivision Name
Harbour View Endo_Gastroenterology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490017W
Medicare Provider Number
490017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
11/22/2013
Participating Start Date
1/1/2014
Participating Approval Date
12/6/2013
Last Recertification Date
8/31/2022
Termination Date
Termination Reason
10/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
Bon Secours Mercy Health
Jonathan Lee Haynes, Hampton Roads Market CFO
(540) 270-2809
Primary Contact
Bon Secours Mercy Health
Autumn Fairfield, 340B Manager
(270) 217-4090
Addresses
Street Address
5818B Harbour View Blvd.
Suite 100
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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