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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
4750 E 450 S
SUITE A
WHITESTOWN, IN 46075
Pharmacy Comments
Contract Details
Approval Date
1/17/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John Carr Simmerman, CFO
(757) 398-2133
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500
Signed By Date
1/17/2022
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