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RIVERSIDE PHARMACY SERVICES
DSH490052 RIVERSIDE REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
RIVERSIDE REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH490052
Entity Address
500 J Clyde Morris Blvd
NEWPORT NEWS, VA 23601
Medicare Provider Number
490052
Participating Start Date
7/1/2008
Last Recertification Date
8/16/2024
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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