340B Drug Pricing Program Database


CAH511319-02 JEFFERSON MEDICAL CENTER (Active) - information as of 4/28/2025 1:49:59 AM

Main Details
JEFFERSON MEDICAL CENTER
Pulmonary - Pulmonary
Critical Access Hospital
Yes
CAH511319-02
511319


Additional Details
Active
7/9/2024
10/1/2024
7/10/2024

Contacts

WVU Medicine East
Grover Glendon Kerns, VP of Finance
(304) 260-1443

The Charles Town General Hospital dba Jefferson Medical Center
JONATHAN Matthew KLINE, DIRECTOR OF PHARMACY
(304) 728-1768

Addresses

201 East 5th Ave
Ranson, WV 25438

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
WV 1104242569,1891722377
OH 1104242569,1891722377
KY 1104242569,1891722377
PA 1104242569,1891722377
VA 1104242569,1891722377
Shipping Addresses

West Virginia United Health System Inc DBA Enterprise Pharmacy Solutions
781 Chestnut Ridge Rd
Suite 600
Morgantown, WV 26505-0015
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
CAH511319-01ChildCAHJEFFERSON MEDICAL CENTERBehavioral Med Ranson - Behavioral Med Ranson205 East 5th StreetRansonWVActive
CAH511319-02ChildCAHJEFFERSON MEDICAL CENTERPulmonary - Pulmonary201 East 5th AveRansonWVActive
CAH511319-03ChildCAHJEFFERSON MEDICAL CENTERFamily Med Ranson - Family Med Ranson203 East 4th AveRansonWVActive
CAH511319-04ChildCAHJEFFERSON MEDICAL CENTERGeneral Surgery Ranson - General Surgery Ranson203 East 4th AveRansonWVActive
CAH511319-05ChildCAHJEFFERSON MEDICAL CENTEROBGYN - Women's Health Ranson201 East 5th AveRansonWVActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressInsertGroup Change Request West Virginia United Health System Inc DBA Enterprise Pharmacy Solutions 781 Chestnut Ridge Rd Suite 600 Morgantown, WV 26505-001510/17/2024 7:24 AM
DetailsStateUpdate ApprovedActive10/1/2024 12:01 AM
ContactsSigned ByInsertNew Registration Kerns, Grover Glendon VP of Finance WVU Medicine East 30426014437/10/2024 9:26 AM
Details340B IDUpdateNew Registration CAH511319-027/10/2024 9:26 AM
DetailsEntity NameUpdateNew RegistrationJEFFERSON MEMORIAL HOSPITALJEFFERSON MEDICAL CENTER7/10/2024 9:26 AM
DetailsEntity SubnameUpdateNew RegistrationPulmonaryPulmonary - Pulmonary7/10/2024 9:26 AM
DatesParticipating Approval DateUpdateNew Registration 7/10/2024 9:26:34 AM7/10/2024 9:26 AM
DetailsStateUpdateNew RegistrationPendingApproved7/10/2024 9:26 AM
DatesSigned By DateUpdateNew Registration 7/9/2024 4:35:50 PM7/10/2024 9:26 AM
DatesStart DateUpdateNew Registration 10/1/2024 12:00:00 AM7/10/2024 9:26 AM
AddressesMain AddressInsertNew Registration  201 East 5th Ave Ranson, WV 254387/9/2024 3:24 PM
Medicaid BillingNPI: NumberInsertNew Registration 11042425697/9/2024 3:24 PM
Medicaid BillingNPI: StateInsertNew Registration WV7/9/2024 3:24 PM
Medicaid BillingNPI: NumberInsertNew Registration 18917223777/9/2024 3:24 PM
Medicaid BillingNPI: StateInsertNew Registration WV7/9/2024 3:24 PM
Medicaid BillingNPI: NumberInsertNew Registration 11042425697/9/2024 3:24 PM
Medicaid BillingNPI: StateInsertNew Registration OH7/9/2024 3:24 PM
Medicaid BillingNPI: NumberInsertNew Registration 18917223777/9/2024 3:24 PM
Medicaid BillingNPI: StateInsertNew Registration OH7/9/2024 3:24 PM
Medicaid BillingNPI: NumberInsertNew Registration 11042425697/9/2024 3:24 PM
Medicaid BillingNPI: StateInsertNew Registration KY7/9/2024 3:24 PM
Medicaid BillingNPI: NumberInsertNew Registration 18917223777/9/2024 3:24 PM
Medicaid BillingNPI: StateInsertNew Registration KY7/9/2024 3:24 PM
Medicaid BillingNPI: NumberInsertNew Registration 11042425697/9/2024 3:24 PM
Medicaid BillingNPI: StateInsertNew Registration PA7/9/2024 3:24 PM
Medicaid BillingNPI: NumberInsertNew Registration 18917223777/9/2024 3:24 PM
Medicaid BillingNPI: StateInsertNew Registration PA7/9/2024 3:24 PM
Medicaid BillingNPI: NumberInsertNew Registration 11042425697/9/2024 3:24 PM
Medicaid BillingNPI: StateInsertNew Registration VA7/9/2024 3:24 PM
Medicaid BillingNPI: NumberInsertNew Registration 18917223777/9/2024 3:24 PM
Medicaid BillingNPI: StateInsertNew Registration VA7/9/2024 3:24 PM
ContactsPrimary ContactInsertNew Registration KLINE, JONATHAN Matthew DIRECTOR OF PHARMACY The Charles Town General Hospital dba Jefferson Medical Center 30472817687/9/2024 3:24 PM
ContactsAuthorizing OfficialInsertNew Registration Kerns, Grover Glendon VP of Finance WVU Medicine East 30426014437/9/2024 3:24 PM
DetailsAssistance Received From DateInsertNew Registration  7/9/2024 3:24 PM
DetailsAssistance Received To DateInsertNew Registration  7/9/2024 3:24 PM
DetailsLast Recertification DateInsertNew Registration  7/9/2024 3:24 PM
DetailsGrant NumberInsertNew Registration  7/9/2024 3:24 PM
Details340B IDInsertNew Registration  7/9/2024 3:24 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  7/9/2024 3:24 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  7/9/2024 3:24 PM
DetailsMedicare Provider NumberInsertNew Registration 5113197/9/2024 3:24 PM
DetailsEntity NameInsertNew Registration JEFFERSON MEMORIAL HOSPITAL7/9/2024 3:24 PM
DetailsNOFO NumberInsertNew Registration  7/9/2024 3:24 PM
DetailsProgram CodeInsertNew Registration CAH7/9/2024 3:24 PM
DetailsEntity SubnameInsertNew Registration Pulmonary7/9/2024 3:24 PM
DatesParticipating Approval DateInsertNew Registration  7/9/2024 3:24 PM
DetailsStateInsertNew Registration Pending7/9/2024 3:24 PM
DatesRegistration DateInsertNew Registration 7/9/2024 3:24:10 PM7/9/2024 3:24 PM
DatesSigned By DateInsertNew Registration  7/9/2024 3:24 PM
DatesStart DateInsertNew Registration  7/9/2024 3:24 PM
TerminationsTermination CommentsInsertNew Registration  7/9/2024 3:24 PM
TerminationsTermination DateInsertNew Registration  7/9/2024 3:24 PM
TerminationsTermination Effective DateInsertNew Registration  7/9/2024 3:24 PM
TerminationsTermination ReasonInsertNew Registration  7/9/2024 3:24 PM