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HARNESS HEALTH PHARMACY
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
HARNESS HEALTH PHARMACY
Pharmacy Address
7160 INDUSTRIAL ROW DR STE 331
MASON, OH 45040
Pharmacy Comments
Contract Details
Approval Date
1/14/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/7/2024
Ownership change
Contacts
Covered Entity Signing Official
Stephan Quiriconi, Senior VP of Finance
(804) 281-8301
Contract Pharmacy Representative
Bon Secours Mercy Health
Behlan Ersoy, System Director Specialty Pharmacy
(513) 557-7661
Signed By Date
1/14/2020
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