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MEDICAL ARTS PHARMACY
DSH490022 MARY WASHINGTON HOSPITAL
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Covered Entity Details
Entity Name
MARY WASHINGTON HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490022
Entity Address
1001 SAM PERRY BLVD
FREDERICKSBURG, VA 22401
Medicare Provider Number
490022
Participating Start Date
7/1/2024
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
MEDICAL ARTS PHARMACY
Pharmacy Address
MARY WASHINGTON HEALTHCARE SERVICES, INC
TOMPKINS-MARTIN MEDICAL PLAZA
1101 SAM PERRY BLVD. SUITE 120
FREDERICKSBURG, VA 22401
Pharmacy Comments
Contract Details
Approval Date
7/10/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sean Timothy Barden, Executive VP & CFO
(540) 741-1494
Contract Pharmacy Representative
Medical Arts Pharmacy Mary Washington Healthcare Services, Inc.
Betty Moran, Business Manager
(540) 741-1463
Signed By Date
7/10/2024
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