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DSH490045C UVA HEALTH PRINCE WILLIAM MEDICAL CENTER (Terminated)
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Main Details
Name
UVA HEALTH PRINCE WILLIAM MEDICAL CENTER
Subdivision Name
NHUVA OP Wound Care - Outpatient Wound Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490045C
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
Other
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
8644 Sudley Rd
Suite 115
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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