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VIRGINIA CVS PHARMACY, L.L.C.
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
VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 2315
401 EAST MERCURY BLVD.
HAMPTON, VA 23663
Pharmacy Comments
Contract Details
Approval Date
1/10/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
WILLIAM W. AUSTIN JR., SENIOR VP & CFO
(757) 534-7015
Contract Pharmacy Representative
CVS Health
Jaclyn Parfitt, 340B Operations Manager
(401) 770-6467
Signed By Date
1/10/2017
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