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RIVERSIDE PHARMACY SERVICES
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
RIVERSIDE PHARMACY SERVICES
Pharmacy Address
848 J. CLYDE MORRIS BLVD.
NEWPORT NEWS, VA 23601
Pharmacy Comments
Contract Details
Approval Date
10/18/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
WILLIAM W. AUSTIN JR., SENIOR VP & CFO
(757) 534-7015
Contract Pharmacy Representative
Riverside Health System
Cynthia Williams, VP/Chief Pharmacy Officer
(757) 784-1569
Signed By Date
10/18/2016
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