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BON SECOURS - VIRGINIA HEALTHSOURCE INC
DSH490094 RICHMOND COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
RICHMOND COMMUNITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490094
Entity Address
1500 North 28TH Street
RICHMOND, VA 23223
Medicare Provider Number
490094
Participating Start Date
1/1/2004
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
BON SECOURS - VIRGINIA HEALTHSOURCE INC
Pharmacy Address
DBA HARNESS HEALTH PHARMACY #502
6900 FOREST AVE STE 100
RICHMOND, VA 23230
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/7/2024
Ownership change
Contacts
Covered Entity Signing Official
Cindy K. Bartlett, VP Corporate Responsibility
(757) 673-5835
Contract Pharmacy Representative
Good Health Pharmacy
Amanda Matassa, Pharmacist in Charge
(804) 442-3754
Signed By Date
10/15/2018
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