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DSH490032JG Virginia Commonwealth University Health System (Terminated)
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Main Details
Name
Virginia Commonwealth University Health System
Subdivision Name
Virginia Commonwealth University Health System - for Sleep Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH490032JG
Medicare Provider Number
490032
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/9/2021
Participating Start Date
10/1/2021
Participating Approval Date
7/26/2021
Last Recertification Date
8/15/2023
Termination Date
Termination Reason
10/1/2024
Site closure
Contacts
Authorizing Official
VCU Health System
Matthew Jenkins, Vice President, Chief Pharmacy Officer
(804) 628-8676
Primary Contact
VCU Health
Kevin D Payne, Pharmacist
(804) 364-6815
Addresses
Street Address
2529 Professional Road
Richmond, VA 23235
Billing Address
VCU Health System Authority
1250 East Marshall Street
Richmond, VA 23298
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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