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DSH490052AL RIVERSIDE REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
RIVERSIDE REGIONAL MEDICAL CENTER
Subdivision Name
RIVERSIDE PULMONARY AND SLEEP SPECI
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490052AL
Medicare Provider Number
490052
Outpatient Facility Provider Number
490052
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/16/2014
Last Recertification Date
9/2/2021
Termination Date
Termination Reason
4/1/2022
Other
Contacts
Authorizing Official
Riverside Healthcare Association Inc
WILLIAM W. AUSTIN JR., SENIOR VP & CFO
(757) 534-7015
Primary Contact
Riverside Health System
Cynthia Williams, VP/Chief Pharmacy Officer
(757) 784-1569
Addresses
Street Address
12200 WARWICK BLVD 290
NEWPORT NEWS, VA 23601-2344
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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