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VCU HEALTH SPECIALTY 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 SPECIALTY PHARMACY
Pharmacy Address
1030 WILMER AVE STE 300
RICHMOND, VA 23227-2403
Pharmacy Comments
Contract Details
Approval Date
4/16/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
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
4/9/2025
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