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GOOD HEALTH PHARMACY AT HANOVER
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
GOOD HEALTH PHARMACY AT HANOVER
Pharmacy Address
8200 MEADOWBRIDGE RD STE 301
MECHANICSVILLE, VA 23116-2337
Pharmacy Comments
Contract Details
Approval Date
1/26/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/18/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mark Gordon, CEO
(804) 764-6102
Contract Pharmacy Representative
Good Health Pharmacy
Amanda Matassa, Pharmacist in Charge
(804) 442-3754
Signed By Date
1/26/2017
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