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PROPRIUM PHARMACY
DSH490009 UNIVERSITY OF VIRGINIA MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY OF VIRGINIA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490009
Entity Address
1215 Lee Street
RECVG LANE RD-LOADING DOCK
CHARLOTTESVILLE, VA 22908
Medicare Provider Number
490009
Participating Start Date
7/1/1993
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
PROPRIUM PHARMACY
Pharmacy Address
535 INDEPENDENCE PKWY STE 400
CHESAPEAKE, VA 23320-5176
Pharmacy Comments
Contract Details
Approval Date
4/13/2021
Contract Begin Date
4/26/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Wilmoth, Strategic Planning and Reimbursement Officer
(434) 243-9802
Contract Pharmacy Representative
Sentara Enterprises
Jim R Schwamburger, Director
(757) 553-3211
Signed By Date
4/13/2021
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