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DSH490052BF RIVERSIDE REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
RIVERSIDE REGIONAL MEDICAL CENTER
Subdivision Name
RIVERSIDE UROLOGY SPECIALISTS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490052BF
Medicare Provider Number
490052
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/12/2015
Last Recertification Date
8/16/2016
Termination Date
Termination Reason
7/1/2017
Site closure
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
7552 HOSPITAL DR
SUITE 302
GLOUCESTER, VA 23061-4178
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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