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BON SECOURS - VIRGINIA HEALTHSOURCE INC.
DSH490094 RICHMOND COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
RICHMOND COMMUNITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490094
Entity Address
1500 North 28TH Street
RICHMOND, VA 23223
Medicare Provider Number
490094
Participating Start Date
1/1/2004
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
BON SECOURS - VIRGINIA HEALTHSOURCE INC.
Pharmacy Address
BON SECOURS GOOD HEALTH PHARMACY AT RICH
1510 N 28TH ST STE 100
RICHMOND, VA 23223
Pharmacy Comments
Contract Details
Approval Date
7/18/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MICHAEL ROBINSON, CHIEF EXECUTIVE OFFICER
(804) 764-6102
Contract Pharmacy Representative
Harness Health Pharmacy
Brent Kovalyak, System Director of Pharmacy Operations
(513) 305-6835
Signed By Date
7/18/2014
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