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DSH490045 UVA HEALTH PRINCE WILLIAM MEDICAL CENTER (Active)
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Main Details
Name
UVA HEALTH PRINCE WILLIAM MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490045
Medicare Provider Number
490045
Additional Details
Current Program Status
Active
Registration Date
7/2/2018
Participating Start Date
10/1/2018
Participating Approval Date
7/11/2018
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
UVA Health System
Brian Wilmoth, Strategic Planning and Reimbursement Officer
(434) 243-9802
Primary Contact
UVA Health System
Jordan T DeAngelis, Director Pharmacy
(434) 982-1950
Addresses
Street Address
8700 SUDLEY ROAD
MANASSAS, VA 20110
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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