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RRC490059-00 ST. MARYS HOSPITAL (Terminated)
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Main Details
Name
ST. MARYS HOSPITAL
Subdivision Name
Type
Rural Referral Center
Rural
No
340B ID
RRC490059-00
Medicare Provider Number
490059
Additional Details
Current Program Status
Terminated
Registration Date
7/7/2021
Participating Start Date
10/1/2021
Participating Approval Date
8/20/2021
Last Recertification Date
8/30/2023
Termination Date
Termination Reason
10/1/2024
Change of covered entity type
Contacts
Authorizing Official
Bon Secours Mercy Health
Gregory S Simmons, Site CFO
(804) 248-8731
Primary Contact
Bon Secours - St. Mary's Hospital
Caroline Briggs, Director of Pharmacy
(804) 287-7807
Addresses
Street Address
5801 BREMO ROAD
RICHMOND, VA 23226
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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