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ACCREDO HEALTH GROUP, INC.
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
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
2 BOULDEN CIR STE 1
NEW CASTLE, DE 19720-3492
Pharmacy Comments
Contract Details
Approval Date
8/9/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Gaden, CEO
(757) 398-2122
Contract Pharmacy Representative
Accredo
Diana Florio, 340B Managing Director
(407) 988-7044
Signed By Date
8/9/2019
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