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DSH490052AP RIVERSIDE REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
RIVERSIDE REGIONAL MEDICAL CENTER
Subdivision Name
RVS PAIN MGMT AND REHAB SPECIALISTS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490052AP
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
7570 MEDICAL DR
Suite 105B
GLOUCESTER, VA 23061-4351
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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