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VCU HEALTH SYSTEM, HOSPITAL PHARMACY
DSH490098 COMMUNITY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
COMMUNITY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490098
Entity Address
1755 N MECKLENBURG AVENUE
SOUTH HILL, VA 23970
Medicare Provider Number
490098
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
VCU HEALTH SYSTEM, HOSPITAL PHARMACY
Pharmacy Address
401 N 12TH ST
RM B-300 P.O. BOX 980042
RICHMOND, VA 23298-0042
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/2/2024
Agreement registered in error
Contacts
Covered Entity Signing Official
Matthew Jenkins, Vice President, Chief Pharmacy Officer
(804) 628-8676
Contract Pharmacy Representative
VCU Health System
Rodney Stiltner, Director of Pharmacy
(804) 828-5468
Signed By Date
1/16/2024
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