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RAYFIELD'S PHARMACY
DSH490037 RIVERSIDE SHORE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
RIVERSIDE SHORE MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490037
Entity Address
20480 Market Street
Onancock, VA 23417
Medicare Provider Number
490037
Participating Start Date
7/1/2004
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
RAYFIELD'S PHARMACY
Pharmacy Address
2 FIG ST
CAPE CHARLES, VA 23310-3322
Pharmacy Comments
Contract Details
Approval Date
12/3/2012
Contract Begin Date
12/3/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/31/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joe Zager, Administrator
(757) 414-8000
Contract Pharmacy Representative
Rayfield's Pharmacy
Severn Rayfield, Owner
(757) 331-1212
Signed By Date
9/21/2012
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