Covered Entity Details

DSH510046F PRINCETON COMMUNITY HOSPITAL (Active) - information as of 4/23/2025 10:55:33 PM

Main Details

Name

PRINCETON COMMUNITY HOSPITAL

Subdivision Name

Bluefield Family Medicine - Bluefield Family Medicine

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH510046F

Medicare Provider Number

510046

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/11/2024

Participating Start Date

1/1/2025

Participating Approval Date

11/4/2024

Last Recertification Date

Contacts

Authorizing Official

Princeton Community Hospital Association, Inc.
Diane Lynn Spencer, VP of Finance/CFO
(304) 487-7505

Primary Contact

Princeton Community Hospital
Daniel Paul Morrison, Director of Pharmacy
(304) 487-7564

Addresses

Street Address

106 Huffard Drive
Bluefield, VA 24605

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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		1558313213,1619053329,1972610863,1972810125,1063729218
VA		1558313213,1619053329,1972610863,1972810125,1063729218
OH		1558313213,1619053329,1972610863,1972810125,1063729218
PA		1558313213,1619053329,1972610863,1972810125,1063729218
KY		1558313213,1619053329,1972610863,1972810125,1063729218

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.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH510046A	Child	DSH	PRINCETON COMMUNITY HOSPITAL	BEHAVIORAL HEALTH PAVILION-OUTPATIENT TREATMENT	1333 SOUTHVIEW DRIVE	BLUEFIELD	WV	Active
DSH510046B	Child	DSH	PRINCETON COMMUNITY HOSPITAL	PRINCETON COMMUNITY HOSPITAL - Rural Health Clinic 2	401 E VERMILLION ST	ATHENS	WV	Active
DSH510046C	Child	DSH	PRINCETON COMMUNITY HOSPITAL	PCH BLUEFIELD ED - Emergency Department	500 CHERRY ST	BLUEFIELD	WV	Active
DSH510046D	Child	DSH	PRINCETON COMMUNITY HOSPITAL	WVU Cancer Institute PCH Cancer Medicine - Hematology/Oncology	122 Twelfth Street	Princeton	WV	Terminated
DSH510046E	Child	DSH	PRINCETON COMMUNITY HOSPITAL	PRINCETON COMMUNITY HOSPITAL ASSOC. - Bluefield Internal Medicine	510 CHERRY ST	BLUEFIELD	WV	Active
DSH510046F	Child	DSH	PRINCETON COMMUNITY HOSPITAL	Bluefield Family Medicine - Bluefield Family Medicine	106 Huffard Drive	Bluefield	VA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	1/1/2025 12:01 AM
Contacts	Signed By	Insert	New Registration		Spencer, Diane Lynn VP of Finance/CFO Princeton Community Hospital Association, Inc. 3044877505	11/4/2024 2:16 PM
Details	340B ID	Update	New Registration		DSH510046F	11/4/2024 2:16 PM
Details	Entity Subname	Update	New Registration	Bluefield Family Medicine	Bluefield Family Medicine - Bluefield Family Medicine	11/4/2024 2:16 PM
Dates	Participating Approval Date	Update	New Registration		11/4/2024 2:16:47 PM	11/4/2024 2:16 PM
Details	State	Update	New Registration	Pending	Approved	11/4/2024 2:16 PM
Dates	Signed By Date	Update	New Registration		11/1/2024 9:34:13 AM	11/4/2024 2:16 PM
Dates	Start Date	Update	New Registration		1/1/2025 12:00:00 AM	11/4/2024 2:16 PM
Addresses	Main Address	Insert	New Registration		106 Huffard Drive Bluefield, VA 24605	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1558313213	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		WV	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1619053329	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		WV	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1972610863	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		WV	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1972810125	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		WV	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1063729218	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		WV	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1558313213	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		VA	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1619053329	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		VA	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1972610863	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		VA	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1972810125	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		VA	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1063729218	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		VA	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1558313213	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		OH	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1619053329	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		OH	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1972610863	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		OH	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1972810125	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		OH	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1063729218	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		OH	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1558313213	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1619053329	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1972610863	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1972810125	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1063729218	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1558313213	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		KY	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1619053329	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		KY	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1972610863	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		KY	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1972810125	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		KY	10/11/2024 1:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1063729218	10/11/2024 1:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		KY	10/11/2024 1:07 PM
Contacts	Authorizing Official	Insert	New Registration		Spencer, Diane Lynn VP of Finance/CFO Princeton Community Hospital Association, Inc. 3044877505	10/11/2024 1:07 PM
Contacts	Primary Contact	Insert	New Registration		Morrison, Daniel Paul Director of Pharmacy Princeton Community Hospital 3044877564	10/11/2024 1:07 PM
Details	Assistance Received From Date	Insert	New Registration			10/11/2024 1:07 PM
Details	Assistance Received To Date	Insert	New Registration			10/11/2024 1:07 PM
Details	Last Recertification Date	Insert	New Registration			10/11/2024 1:07 PM
Details	Grant Number	Insert	New Registration			10/11/2024 1:07 PM
Details	340B ID	Insert	New Registration			10/11/2024 1:07 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/11/2024 1:07 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/11/2024 1:07 PM
Details	Medicare Provider Number	Insert	New Registration		510046	10/11/2024 1:07 PM
Details	Entity Name	Insert	New Registration		PRINCETON COMMUNITY HOSPITAL	10/11/2024 1:07 PM
Details	NOFO Number	Insert	New Registration			10/11/2024 1:07 PM
Details	Program Code	Insert	New Registration		DSH	10/11/2024 1:07 PM
Details	Entity Subname	Insert	New Registration		Bluefield Family Medicine	10/11/2024 1:07 PM
Dates	Participating Approval Date	Insert	New Registration			10/11/2024 1:07 PM
Details	State	Insert	New Registration		Pending	10/11/2024 1:07 PM
Dates	Registration Date	Insert	New Registration		10/11/2024 1:07:58 PM	10/11/2024 1:07 PM
Dates	Signed By Date	Insert	New Registration			10/11/2024 1:07 PM
Dates	Start Date	Insert	New Registration			10/11/2024 1:07 PM
Terminations	Termination Comments	Insert	New Registration			10/11/2024 1:07 PM
Terminations	Termination Date	Insert	New Registration			10/11/2024 1:07 PM
Terminations	Termination Effective Date	Insert	New Registration			10/11/2024 1:07 PM
Terminations	Termination Reason	Insert	New Registration			10/11/2024 1:07 PM