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PROPRIUM PHARMACY
SCH490013-00 SENTARA HALIFAX REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
SENTARA HALIFAX REGIONAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH490013-00
Entity Address
2204 WILBORN AVENUE
SOUTH BOSTON, VA 24592
Medicare Provider Number
490013
Participating Start Date
10/1/2023
Last Recertification Date
8/29/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
PROPRIUM PHARMACY
Pharmacy Address
535 INDEPENDENCE PKWY STE 400
CHESAPEAKE, VA 23320-5176
Pharmacy Comments
Contract Details
Approval Date
7/29/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/15/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Brian Keith Zwoyer, President
(434) 517-3196
Contract Pharmacy Representative
Sentara Enterprises
Jim R Schwamburger, Director
(757) 553-3211
Signed By Date
7/29/2021
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