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DSH490032JB Virginia Commonwealth University Health System (Terminated)
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Main Details
Name
Virginia Commonwealth University Health System
Subdivision Name
NEUROSCIENCE ORTHOPEDIC WELLNESS CE - Neuro Ophthalmology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH490032JB
Medicare Provider Number
490032
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2020
Participating Start Date
10/1/2020
Participating Approval Date
7/21/2020
Last Recertification Date
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
VCU Health System
Paul Wesolowski, Chief Operating Officer
(804) 828-4607
Primary Contact
VCU Health
Kevin D Payne, Pharmacist
(804) 364-6815
Addresses
Street Address
11958 W BROAD ST
HENRICO, VA 23233-1007
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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