340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH490045E UVA HEALTH PRINCE WILLIAM MEDICAL CENTER (Terminated)
Print
Main Details
Name
UVA HEALTH PRINCE WILLIAM MEDICAL CENTER
Subdivision Name
Cardiac Rehab - 5108 - Cardiac Rehab
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490045E
Medicare Provider Number
490045
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2023
Participating Start Date
4/1/2023
Participating Approval Date
2/15/2023
Last Recertification Date
8/12/2024
Termination Date
Termination Reason
4/1/2025
Hospital Outpatient facility no longer eligible
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
8640 Sudley Road
104
Manassas, VA 20110
Billing Address
UVA Health System
8700 Sudley Road
Manassas, VA 20110
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
May 2025
May 2025
week
S
M
T
W
T
F
S
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
20
11
12
13
14
15
16
17
21
18
19
20
21
22
23
24
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session