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DSH490032DK VCU HEALTH SYSTEM MCV HOSPITAL (Terminated)
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Main Details
Name
VCU HEALTH SYSTEM MCV HOSPITAL
Subdivision Name
Hemodialysis
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH490032DK
Medicare Provider Number
490032
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2016
Participating Start Date
7/1/2016
Participating Approval Date
5/18/2016
Last Recertification Date
8/30/2016
Termination Date
Termination Reason
10/1/2017
Site closure
Contacts
Authorizing Official
VCU Health System
Paul Wesolowski, Chief Operating Officer
(804) 828-4607
Primary Contact
VCU Health System
Rodney Stiltner, Director of Pharmacy
(804) 828-5468
Addresses
Street Address
1213 E Clay St
Richmond, VA 23298
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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