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DSH490032DL VCU HEALTH SYSTEM MCV HOSPITAL (Terminated)
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Main Details
Name
VCU HEALTH SYSTEM MCV HOSPITAL
Subdivision Name
Inflammatory Bowel Disease / Pancreatitis Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH490032DL
Medicare Provider Number
490032
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/8/2016
Participating Start Date
10/1/2016
Participating Approval Date
9/14/2016
Last Recertification Date
Termination Date
Termination Reason
4/1/2017
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
1300 E Marshall Street
5th Floor
Richmond, VA 23298
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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