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DSH490052BT RIVERSIDE REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
RIVERSIDE REGIONAL MEDICAL CENTER
Subdivision Name
Riverside Urology Specialists - Urology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490052BT
Medicare Provider Number
490052
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/13/2020
Participating Start Date
10/1/2020
Participating Approval Date
7/23/2020
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Riverside Healthcare Association Inc
WILLIAM W. AUSTIN JR., SENIOR VP & CFO
(757) 534-7015
Primary Contact
Riverside Health System
Cynthia Williams, VP/Chief Pharmacy Officer
(757) 784-1569
Addresses
Street Address
850 Enterprise Parkway
Suite 2000
Hampton, VA 23666
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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