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BON SECOURS - VIRGINIA HEALTHSOURCE INC
DSH490059 BON SECOURS - ST. MARYS HOSPITAL
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Covered Entity Details
Entity Name
BON SECOURS - ST. MARYS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490059
Entity Address
5801 BREMO ROAD
RICHMOND, VA 23226
Medicare Provider Number
490059
Participating Start Date
10/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
BON SECOURS - VIRGINIA HEALTHSOURCE INC
Pharmacy Address
DBA HARNESS HEALTH PHARMACY #502
6900 FOREST AVE STE 100
RICHMOND, VA 23230
Pharmacy Comments
Contract Details
Approval Date
7/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/7/2024
Ownership change
Contacts
Covered Entity Signing Official
Gregory S Simmons, Site CFO
(804) 248-8731
Contract Pharmacy Representative
Good Health Pharmacy
Amanda Matassa, Pharmacist in Charge
(804) 442-3754
Signed By Date
7/11/2024
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