Covered Entity Details

CH03182H CABIN CREEK HEALTH SYSTEMS, INC. (Active) - information as of 5/23/2025 10:32:26 PM

Main Details

Name

CABIN CREEK HEALTH SYSTEMS, INC.

Subdivision Name

Westside Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-033876

340B ID

CH03182H

Grant Number

H80CS00294

Additional Details

Current Program Status

Active

Registration Date

4/1/2024

Participating Start Date

7/1/2024

Participating Approval Date

4/18/2024

Last Recertification Date

2/17/2025

Contacts

Authorizing Official

Cabin Creek Health Systems
Amber Renee Crist, Chief Operating Officer
(304) 444-2146

Primary Contact

Cabin Creek Health Systems
Jerad Lee Bailey, Director of Pharmacy Operations
(304) 734-2040 Ext: 1324

Addresses

Street Address

303 Ohio Ave
Charleston, WV 25302-2212

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
WV		1194596759

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH031820	Active	BPS-H80-002203	CABIN CREEK HEALTH SYSTEMS, INC.	Cabin Creek Health Center	5722 Cabin Creek Road		DAWES	WV
CH03182A	Active	BPS-H80-002362	CABIN CREEK HEALTH CENTER, INC.	Riverside Health Center	ONE WARRIOR WAY, SUITE 103		BELLE	WV
CH03182B	Active	BPS-H80-020778	CABIN CREEK HEALTH CENTER, INC.	Sissonville Health Center	6135 SISSONVILLE DRIVE		Charleston	WV
CH03182C	Active	BPS-H80-011055	CABIN CREEK HEALTH CENTER, INC.	Clendenin Health Center	107 Koontz Ave	STE 200	Clendenin	WV
CH03182D	Active	BPS-H80-012037	CABIN CREEK HEALTH SYSTEMS, INC.	Kanawha City Health Center	4602 Maccorkle Ave SE		Charleston	WV
CH03182E	Active	BPS-H80-007518	CABIN CREEK HEALTH SYSTEMS, INC.	Pioneer Health Center	1st and Brannon Street		East Bank	WV
CH03182F	Active	BPS-H80-008177	CABIN CREEK HEALTH SYSTEMS, INC.	Indian Health Center	6100 Sissonville Drive		Sissonville	WV
CH03182G	Terminated	BPS-H80-021933	CABIN CREEK HEALTH SYSTEMS, INC.	Sunnyside Health Center	108 Lee Street, East Suite 129		Charleston	WV
CH03182H	Active	BPS-H80-033876	CABIN CREEK HEALTH SYSTEMS, INC.	Westside Health Center	303 Ohio Ave		Charleston	WV

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH031820	FRUTH PHARMACY #25	FRUTH EXPRESS	701 LEE STREET	CHARLESTON	WV	25301	01/01/2020	01/01/2021
CH031820	FRUTH PHARMACY AT PRESTERA CENTER	FRUTH PHARMACY #104	511 MORRIS ST	CHARLESTON	WV	25301	01/01/2020	01/01/2021
CH031820	KROGER PHARMACY	500 DELAWARE AVE		CHARLESTON	WV	25302	01/01/2020	01/01/2021
CH031820	KROGER PHARMACY #754	10635 MACCORKLE AVE. S.E.		MARMET	WV	25315	01/01/2020	01/01/2021
CH031820	KROGER PHARMACY #769	5 RIVERWALK MALL		SOUTH CHARLESTON	WV	25303	01/01/2020	01/01/2021
CH031820	KROGER PHARMACY #772	5717 MACCORKLE AVENUE SE		CHARLESTON	WV	25304	01/01/2020	01/01/2021
CH031820	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2020	01/01/2021
CH031820	WAL-MART PHARMACY 10-2036	2700 MOUNTAINEER BLVD		SOUTH CHARLESTON	WV	25309	01/01/2020	01/01/2021
CH031820	WAL-MART PHARMACY 10-2576	100 NITRO MARKETPLACE		CROSS LANES	WV	25313	01/01/2020	01/01/2021
CH031820	WAL-MART PHARMACY 10-4278	1001 WARRIOR WAY		QUINCY	WV	25015	01/01/2020	01/01/2021
CH031820	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2020	01/01/2021

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		2/17/2025 2:00:34 PM	2/17/2025 2:00 PM
Details	State	Update		Approved	Active	7/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Crist, Amber Renee Chief Operating Officer Cabin Creek Health Systems 3044442146	4/18/2024 9:40 AM
Details	340B ID	Update	New Registration		CH03182H	4/18/2024 9:40 AM
Dates	Participating Approval Date	Update	New Registration		4/18/2024 9:40:54 AM	4/18/2024 9:40 AM
Details	State	Update	New Registration	Pending	Approved	4/18/2024 9:40 AM
Dates	Signed By Date	Update	New Registration		4/1/2024 11:27:29 AM	4/18/2024 9:40 AM
Dates	Start Date	Update	New Registration		7/1/2024 12:00:00 AM	4/18/2024 9:40 AM
Addresses	Main Address	Insert	New Registration		303 Ohio Ave Charleston, WV 25302-2212	4/1/2024 9:22 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1194596759	4/1/2024 9:22 AM
Medicaid Billing	NPI: State	Insert	New Registration		WV	4/1/2024 9:22 AM
Contacts	Authorizing Official	Insert	New Registration		Crist, Amber Renee Chief Operating Officer Cabin Creek Health Systems 3044442146	4/1/2024 9:22 AM
Contacts	Primary Contact	Insert	New Registration		Bailey, Jerad Lee Director of Pharmacy Operations Cabin Creek Health Systems 3047342040-1324	4/1/2024 9:22 AM
Details	Assistance Received From Date	Insert	New Registration			4/1/2024 9:22 AM
Details	Assistance Received To Date	Insert	New Registration			4/1/2024 9:22 AM
Details	Last Recertification Date	Insert	New Registration			4/1/2024 9:22 AM
Details	Grant Number	Insert	New Registration		H80CS00294	4/1/2024 9:22 AM
Details	340B ID	Insert	New Registration			4/1/2024 9:22 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/1/2024 9:22 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/1/2024 9:22 AM
Details	Medicare Provider Number	Insert	New Registration			4/1/2024 9:22 AM
Details	Entity Name	Insert	New Registration		CABIN CREEK HEALTH SYSTEMS, INC.	4/1/2024 9:22 AM
Details	NOFO Number	Insert	New Registration			4/1/2024 9:22 AM
Details	Program Code	Insert	New Registration		CH	4/1/2024 9:22 AM
Details	Entity Subname	Insert	New Registration		Westside Health Center	4/1/2024 9:22 AM
Dates	Participating Approval Date	Insert	New Registration			4/1/2024 9:22 AM
Details	State	Insert	New Registration		Pending	4/1/2024 9:22 AM
Dates	Registration Date	Insert	New Registration		4/1/2024 9:22:41 AM	4/1/2024 9:22 AM
Dates	Signed By Date	Insert	New Registration			4/1/2024 9:22 AM
Dates	Start Date	Insert	New Registration			4/1/2024 9:22 AM
Terminations	Termination Comments	Insert	New Registration			4/1/2024 9:22 AM
Terminations	Termination Date	Insert	New Registration			4/1/2024 9:22 AM
Terminations	Termination Effective Date	Insert	New Registration			4/1/2024 9:22 AM
Terminations	Termination Reason	Insert	New Registration			4/1/2024 9:22 AM

340B Drug Pricing Program Database