Yes
| WV | | 1457389249,1851539381 |
| OH | | 1457389249,1851539381 |
| PA | | 1457389249,1851539381 |
| VA | | 1457389249,1851539381 |
| KY | | 1457389249,1851539381 |
West Virginia United Health System Inc DBA Enterprise Pharmacy Solutions
781 Chestnut Ridge Rd
Suite 600
Morgantown, WV 26505-0015
| DSH510008A | Child | DSH | City Hospital, Inc. DBA Berkeley Medical Center | Cancer and Infusion Center, a Dept of Berkeley Medical Center | 2000 Foundation Way | Martinsburg | WV | Active |
| DSH510008B | Child | DSH | City Hospital, Inc. DBA Berkeley Medical Center | WVU MEDICINE INFECTIOUS DISEASES - Infectious Diseases | 155 Health Care Lane | MARTINSBURG | WV | Active |
| DSH510008C | Child | DSH | City Hospital, Inc. DBA Berkeley Medical Center | Outpatient Surgery - MOB3 Outpatient Surgery | 880 N. Tennessee Ave | Martinsburg | WV | Active |
| DSH510008D | Child | DSH | City Hospital, Inc. DBA Berkeley Medical Center | OBGYN - Obstetrics & Gynecology | 880 N Tennessee Avenue | Martinsburg | WV | Active |
| DSH510008E | Child | DSH | City Hospital, Inc. DBA Berkeley Medical Center | ENT - Otolaryngology | 2000 Foundation Way | Martinsburg | WV | Active |
| DSH510008F | Child | DSH | City Hospital, Inc. DBA Berkeley Medical Center | Neurosurgery East - Neurosurgery East | 61 Campus Drive | Martinsburg | WV | Active |
| DSH510008G | Child | DSH | City Hospital, Inc. DBA Berkeley Medical Center | Gastroenterology - Gastroenterology | 880 N. Tennessee Ave | Martinsburg | WV | Active |
| DSH510008H | Child | DSH | City Hospital, Inc. DBA Berkeley Medical Center | HVI - Heart and Vascular | 2000 Foundation Way | Martinsburg | WV | Active |
| DSH510008J | Child | DSH | City Hospital, Inc. DBA Berkeley Medical Center | Surgical Associates - Surgical Associates | 2000 Foundation Way | Martinsburg | WV | Active |
| DSH510008K | Child | DSH | City Hospital, Inc. DBA Berkeley Medical Center | Wound Care Center - Wound Management Center | 2000 Foundation Way | Martinsburg | WV | Active |
| DSH510008L | Child | DSH | City Hospital, Inc. DBA Berkeley Medical Center | Urology - Urology | 880 N Tennessee Avenue | Martinsburg | WV | Active |
| DSH510008M | Child | DSH | City Hospital, Inc. DBA Berkeley Medical Center | Rheumatology - Rheumatoloty | 2010 Doctor Oates Drive | Martinsburg | WV | Active |
| DSH510008N | Child | DSH | City Hospital, Inc. DBA Berkeley Medical Center | Pulmonology - Pulmonology | 2000 Foundation Way | Martinsburg | WV | Active |
| DSH510008P | Child | DSH | City Hospital, Inc. DBA Berkeley Medical Center | Behavorial Medicine - Psychiatry | 2010 Doctor Oates Drive | Martinsburg | WV | Active |
| DSH510008Q | Child | DSH | City Hospital, Inc. DBA Berkeley Medical Center | WVU MEDICINE - BMC INTERNAL MEDICIN - Internal Medicine | 1002 SUSHRUTA DR | MARTINSBURG | WV | Active |
| Addresses | Shipping Address | Insert | Group Change Request | | West Virginia United Health System Inc DBA Enterprise Pharmacy Solutions
781 Chestnut Ridge Rd
Suite 600
Morgantown, WV 26505-0015 | 10/22/2024 10:59 AM |
| Details | State | Update | | Approved | Active | 10/1/2024 12:01 AM |
| Contacts | Signed By | Insert | New Registration | | Kerns, Grover Glendon
VP of Finance
WVU Medicine East
3042601443 | 7/22/2024 2:39 PM |
| Details | 340B ID | Update | New Registration | | DSH510008K | 7/22/2024 2:39 PM |
| Details | Entity Name | Update | New Registration | CITY HOSPITAL INC. | City Hospital, Inc. DBA Berkeley Medical Center | 7/22/2024 2:39 PM |
| Details | Entity Subname | Update | New Registration | Wound Care Center | Wound Care Center - Wound Management Center | 7/22/2024 2:39 PM |
| Dates | Participating Approval Date | Update | New Registration | | 7/22/2024 2:39:07 PM | 7/22/2024 2:39 PM |
| Details | State | Update | New Registration | Pending | Approved | 7/22/2024 2:39 PM |
| Dates | Signed By Date | Update | New Registration | | 7/3/2024 3:49:40 PM | 7/22/2024 2:39 PM |
| Dates | Start Date | Update | New Registration | | 10/1/2024 12:00:00 AM | 7/22/2024 2:39 PM |
| Addresses | Main Address | Insert | New Registration | |
2000 Foundation Way
Suite 3100
Martinsburg, WV 25401 | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1457389249 | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | WV | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1851539381 | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | WV | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1457389249 | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | OH | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1851539381 | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | OH | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1457389249 | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | PA | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1851539381 | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | PA | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1457389249 | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | VA | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1851539381 | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | VA | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1457389249 | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | KY | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1851539381 | 7/3/2024 1:59 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | KY | 7/3/2024 1:59 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Kerns, Grover Glendon
VP of Finance
WVU Medicine East
3042601443 | 7/3/2024 1:59 PM |
| Contacts | Primary Contact | Insert | New Registration | | Miller, Christian
Pharmacy Director
Berkeley Medical Center
3042641219 | 7/3/2024 1:59 PM |
| Details | Assistance Received From Date | Insert | New Registration | | | 7/3/2024 1:59 PM |
| Details | Assistance Received To Date | Insert | New Registration | | | 7/3/2024 1:59 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 7/3/2024 1:59 PM |
| Details | Grant Number | Insert | New Registration | | | 7/3/2024 1:59 PM |
| Details | 340B ID | Insert | New Registration | | | 7/3/2024 1:59 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 7/3/2024 1:59 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 7/3/2024 1:59 PM |
| Details | Medicare Provider Number | Insert | New Registration | | 510008 | 7/3/2024 1:59 PM |
| Details | Entity Name | Insert | New Registration | | CITY HOSPITAL INC. | 7/3/2024 1:59 PM |
| Details | NOFO Number | Insert | New Registration | | | 7/3/2024 1:59 PM |
| Details | Program Code | Insert | New Registration | | DSH | 7/3/2024 1:59 PM |
| Details | Entity Subname | Insert | New Registration | | Wound Care Center | 7/3/2024 1:59 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 7/3/2024 1:59 PM |
| Details | State | Insert | New Registration | | Pending | 7/3/2024 1:59 PM |
| Dates | Registration Date | Insert | New Registration | | 7/3/2024 1:59:33 PM | 7/3/2024 1:59 PM |
| Dates | Signed By Date | Insert | New Registration | | | 7/3/2024 1:59 PM |
| Dates | Start Date | Insert | New Registration | | | 7/3/2024 1:59 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 7/3/2024 1:59 PM |
| Terminations | Termination Date | Insert | New Registration | | | 7/3/2024 1:59 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 7/3/2024 1:59 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 7/3/2024 1:59 PM |