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DSH490032BB Virginia Commonwealth University Health System (Terminated)
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Main Details
Name
Virginia Commonwealth University Health System
Subdivision Name
VCU Health System RMC Ophthalmology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH490032BB
Medicare Provider Number
490032
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/14/2015
Last Recertification Date
8/23/2021
Termination Date
Termination Reason
10/1/2022
Site closure
Contacts
Authorizing Official
VCU Health System
James Vincent Willis, VP Professional Services
(804) 628-3002
Primary Contact
VCU Health
Kevin D Payne, Pharmacist
(804) 364-6815
Addresses
Street Address
8700 Stony Point Parkway
2nd Floor
Richmond, VA 23235
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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