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DSH490045B UVA HEALTH PRINCE WILLIAM MEDICAL CENTER (Active)
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Main Details
Name
UVA HEALTH PRINCE WILLIAM MEDICAL CENTER
Subdivision Name
Ancillary Sleep/Neuro - 3156
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490045B
Medicare Provider Number
490045
Outpatient Facility Provider Number
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
8640 Sudley Rd, Building 2
Suite 114
Manassas, VA 20110
Billing Address
UVA Health System
8700 Sudley Road
Manassas, VA 20110
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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