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DSH490052AU RIVERSIDE REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
RIVERSIDE REGIONAL MEDICAL CENTER
Subdivision Name
RIVERSIDE WEIGHT LOSS SPECIALISTS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490052AU
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
8/16/2018
Termination Date
Termination Reason
10/1/2019
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
850 ENTERPRISE PKWY
Suite 1300
HAMPTON, VA 23666-6251
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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