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DSH490045D UVA HEALTH PRINCE WILLIAM MEDICAL CENTER (Terminated)
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Main Details
Name
UVA HEALTH PRINCE WILLIAM MEDICAL CENTER
Subdivision Name
NHUVA Diabetes Center - UVA - Diabetes Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490045D
Medicare Provider Number
490045
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/2/2018
Participating Start Date
10/1/2018
Participating Approval Date
7/11/2018
Last Recertification Date
8/15/2023
Termination Date
Termination Reason
4/1/2024
Hospital Outpatient facility no longer eligible
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 108
Manassas, VA 20110
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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