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DSH490032BZ Virginia Commonwealth University Health System (Active)
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Main Details
Name
Virginia Commonwealth University Health System
Subdivision Name
Pediatric Primary Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH490032BZ
Medicare Provider Number
490032
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/7/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/16/2015
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
VCU Health System
Matthew Jenkins, Vice President, Chief Pharmacy Officer
(804) 628-8676
Primary Contact
VCU Health
Kevin D Payne, Pharmacist
(804) 364-6815
Addresses
Street Address
1000 E Broad Street
4th Floor Pod G
Richmond, VA 23298
Billing Address
VCU Health System Authority
1250 East Marshall Street
Richmond, VA 23298
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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