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DSH490017Z BON SECOURS MARYVIEW MEDICAL CENTER (Terminated)
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Main Details
Name
BON SECOURS MARYVIEW MEDICAL CENTER
Subdivision Name
Bon Secours Medical Oncology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490017Z
Medicare Provider Number
490017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/17/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/15/2017
Last Recertification Date
8/31/2022
Termination Date
Termination Reason
4/1/2023
Site closure
Contacts
Authorizing Official
Bon Secours Mercy Health
Jonathan Lee Haynes, Hampton Roads Market CFO
(540) 270-2809
Primary Contact
Bon Secours
Danielle Bouldin, Director of Pharmacy
(757) 398-2192
Addresses
Street Address
155 Kingsley Lane
Suite 150
Norfolk, VA 23505
Billing Address
Bon Secours Maryview Medical Center
3636 High St
Portsmouth, VA 23707
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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