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VIRGINIA CVS PHARMACY, L.L.C.
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
VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01556
1170 EMMET ST N
CHARLOTTESVILLE, VA 22903
Pharmacy Comments
Contract Details
Approval Date
4/12/2023
Contract Begin Date
4/17/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Wilmoth, Strategic Planning and Reimbursement Officer
(434) 243-9802
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/12/2023
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