340B Drug Pricing Program Database
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DSH490017S BON SECOURS MARYVIEW MEDICAL CENTER (Terminated)
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Main Details
Name
BON SECOURS MARYVIEW MEDICAL CENTER
Subdivision Name
Cardiology Services Harbourview
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490017S
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
4/1/2023
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
Danielle Bouldin, Director of Pharmacy
(757) 398-2192
Addresses
Street Address
5838 Harbour View Blvd.
Suite 220
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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