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DSH490009DB UNIVERSITY OF VIRGINIA MEDICAL CENTER (Terminated)
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Main Details
Name
UNIVERSITY OF VIRGINIA MEDICAL CENTER
Subdivision Name
Dental Peds - 2321
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH490009DB
Medicare Provider Number
490009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/7/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/10/2015
Last Recertification Date
8/24/2022
Termination Date
Termination Reason
7/1/2023
Site closure
Contacts
Authorizing Official
UVA Health System
Brian Wilmoth, Strategic Planning and Reimbursement Officer
(434) 243-9802
Primary Contact
UVA Health System
Danielle Griggs, Pharmacy Director, Business Services
(434) 297-5582
Addresses
Street Address
1204 West Main Street
Charlottesville, VA 22908
Billing Address
UVA Health System
1215 Lee Street
Charlottesville, VA 22908
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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