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ACRO PHARMACEUTICAL SERVICES LLC
DSH490017 Maryview Hospital LLC
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Covered Entity Details
Entity Name
Maryview Hospital LLC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490017
Entity Address
3636 HIGH ST
PORTSMOUTH, VA 23707
Medicare Provider Number
490017
Participating Start Date
4/1/2009
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
ACRO PHARMACEUTICAL SERVICES LLC
Pharmacy Address
ACRO PHARMACEUTICAL SERVICES LLC
313 HENDERSON DR
SHARON HILL, PA 19079
Pharmacy Comments
Contract Details
Approval Date
1/24/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/17/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Paul Gaden, CEO
(757) 398-2122
Contract Pharmacy Representative
Commcare Specialty Pharmacy
Bob Raffalo, VP Operations
(954) 284-2384
Signed By Date
1/24/2019
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