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HARNESS HEALTH PHARMACY-CENTRAL PHARMACY
DSH490017 Maryview Hospital LLC
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Covered Entity Details
Entity Name
Maryview Hospital LLC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490017
Entity Address
3636 HIGH ST
PORTSMOUTH, VA 23707
Medicare Provider Number
490017
Participating Start Date
4/1/2009
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
HARNESS HEALTH PHARMACY-CENTRAL PHARMACY
Pharmacy Address
DBA HARNESS HEALTH PHARMACY #331
7160 INDUSTRIAL ROW DR STE 331
MASON, OH 45040
Pharmacy Comments
Contract Details
Approval Date
11/4/2024
Contract Begin Date
11/7/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jonathan Lee Haynes, Hampton Roads Market CFO
(540) 270-2809
Contract Pharmacy Representative
Harness Health Pharmacy
Behlan Ersoy, System Director Specialty Pharmacy
(513) 557-7661
Signed By Date
11/4/2024
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