Covered Entity Details

DSH510055BR Cabell Huntington Hospital, Inc. (Approved) - information as of 4/30/2025 10:57:27 PM

Main Details

Name

Cabell Huntington Hospital, Inc.

Subdivision Name

CHH Urodynamics - Urodynamics

Type

Disproportionate Share Hospital

Rural

340B ID

DSH510055BR

Medicare Provider Number

510055

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/7/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/8/2025

Last Recertification Date

Contacts

Authorizing Official

St. Mary's Medical Center
Aaron C Blevins, Chief Pharmacy Officer
(304) 526-8250

Primary Contact

Cabell Huntington Hospital
Rebecca Briana Crutchley, 340B Coordinator
(304) 399-4690

Addresses

Street Address

1115 20th Street
Suite 107
Huntington, WV 25703

Billing Address

Cabell Huntington Hospital, Inc.
1340 Hal Greer Blvd
Huntington, WV 25701-0195

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
KY	01690049	1073518007
WV	1073518007	1073518007
OH	1217758	1073518007

Shipping Addresses

Shipping Address 1

Cabell Huntington Hospital, Inc.
1340 Hal Greer Blvd
Huntington, WV 25701-0195

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
DSH510055A	Child	DSH	Cabell Huntington Hospital, Inc.	ECCC-Edwards Comprehensive Cancer Center (CHH/ECCC)	1400 Hal Greer Blvd.	Huntington	WV	Active
DSH510055AA	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Urology (CHH/MH)	1115 20th Street	Huntington	WV	Active
DSH510055AB	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Kidney & Hypertension Center (J. Robert Pritchard Dialysis Center) (CHH/MH)	1690 Medical Center Drive	Huntington	WV	Active
DSH510055AC	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Internal Medicine (Byrd Clinical Center) (CHH/MH)	1249 15th Street	Huntington	WV	Active
DSH510055AD	Child	DSH	CABELL HUNTINGTON HOSPITAL, INC.	Cabell Huntington Hospital Home Health - Catlettsburg	3348 Court Street	Catlettsburg	KY	Terminated
DSH510055AE	Child	DSH	CABELL HUNTINGTON HOSPITAL, INC.	Cabell Huntington Hospital Home Health - Proctorville	25 Leon Alley	Proctorville	OH	Terminated
DSH510055AF	Child	DSH	Cabell Huntington Hospital, Inc.	Cabell Huntington Hospital Home Health - Proctorville (s)	7718 Co RD 107, Suite 102	Proctorville	OH	Terminated
DSH510055AG	Child	DSH	Cabell Huntington Hospital, Inc.	Home Health - Huntington	1340 Hal Greer Blvd.	Huntington	WV	Terminated
DSH510055AH	Child	DSH	Cabell Huntington Hospital, Inc.	Cabell Huntington Hospital Home Health - Catlettsburg	3333 Court Street, Suite 2	Catlettsburg	KY	Terminated
DSH510055AJ	Child	DSH	Cabell Huntington Hospital, Inc.	CHH Family Medical Center (Proctorville)	7718 Co Rd 107	Proctorville	OH	Active
DSH510055AK	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Cardiology (Byrd Clinical Center) (CHH/MH)	1249 15th Street	Huntington	WV	Active
DSH510055AL	Child	DSH	Cabell Huntington Hospital, Inc.	CHH Women's Health (Merritt's Creek)	104 Meadow Pointe	Barboursville	WV	Active
DSH510055AM	Child	DSH	Cabell Huntington Hospital, Inc.	CHH Family Practice (Barboursville)	5727 US Route 60.	Barboursville	WV	Active
DSH510055AN	Child	DSH	Cabell Huntington Hospital, Inc.	CHH Express Care (Fruth Pharmacy) (Hurricane)	3109 Teays Valley Road	Hurricane	WV	Terminated
DSH510055AP	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Senior Pain and Wellness Center (CHH/MH)	1115 20th Street	Huntington	WV	Active
DSH510055AQ	Child	DSH	Cabell Huntington Hospital, Inc.	CHH Woodlands Primary Care Clinic	500 Bradley Foster Drive	Huntington	WV	Terminated
DSH510055AR	Child	DSH	Cabell Huntington Hospital, Inc.	CHH Outpatient Infusion Center	1300 3rd Ave	Huntington	WV	Active
DSH510055AS	Child	DSH	Cabell Huntington Hospital, Inc.	ECCC PET CT Scan (CHH/ECCC)	1400 Hal Greer Blvd.	Huntington	WV	Active
DSH510055AT	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Psychiatry - Marshall Mind Wellness Center (CHH/MH)	1115 20th Street	Huntington	WV	Active
DSH510055AU	Child	DSH	Cabell Huntington Hospital, Inc.	ECCC Pediatric Infusion (CHH/ECCC)	1400 Hal Greer Blvd.	Huntington	WV	Active
DSH510055AV	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Family Medicine-Center For Healthy Aging (CHH/MH)	659 Central Avenue, Rear	Barboursville	WV	Active
DSH510055AW	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Cardiology Imaging (Byrd Clinical Center) (CHH/MH)	1249 15th Street	Huntington	WV	Active
DSH510055AX	Child	DSH	Cabell Huntington Hospital, Inc.	ECCC Diagnostic Breast Center (CHH/ECCC)	1400 Hal Greer Blvd.	Huntington	WV	Active
DSH510055AY	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Neuroscience - Neurosurgery (CHH/MH)	1600 Medical Center Drive	Huntington	WV	Active
DSH510055AZ	Child	DSH	Cabell Huntington Hospital, Inc.	ECCC Radiation Oncology (CHH/ECCC)	1400 Hal Greer Blvd.	Huntington	WV	Active
DSH510055B	Child	DSH	Cabell Huntington Hospital, Inc.	CHH Family Medical Center (Kenova)	750 Oak Str.	Kenova	WV	Active
DSH510055BA	Child	DSH	Cabell Huntington Hospital, Inc.	ECCC Surgical Oncology (CHH/ECCC)	1400 Hal Greer Blvd.	Huntington	WV	Active
DSH510055BB	Child	DSH	Cabell Huntington Hospital, Inc.	ECCC Medical Oncology (CHH/ECCC)	1400 Hal Greer Blvd.	Huntington	WV	Active
DSH510055BC	Child	DSH	Cabell Huntington Hospital, Inc.	CHH Cannonsburg Primary Care	6572 Midland Trail	Ashland	KY	Terminated
DSH510055BD	Child	DSH	Cabell Huntington Hospital, Inc.	ECCC Adult Infusion (CHH/ECCC)	1400 Hal Greer Blvd.	Huntington	WV	Active
DSH510055BE	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Dermatology - Mohs Surgery	1305 Elm Street	Huntington	WV	Active
DSH510055BF	Child	DSH	Cabell Huntington Hospital, Inc.	CHH Perinatal Center	1616 13th Avenue	Huntington	WV	Active
DSH510055BG	Child	DSH	Cabell Huntington Hospital, Inc.	CHH Center for Surgical Weight Control-Bariatrics	1115 20th Street	Huntington	WV	Active
DSH510055BH	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Pediatric Specialties-Teays Valley (CHH/MH)	300 Corporate Center Drive	Scott Depot	WV	Active
DSH510055BJ	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Dermatology-Teays Valley (CHH/MH)	300 Corporate Center Drive	Scott Depot	WV	Active
DSH510055BK	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Orthopaedics-Teays Valley (CHH/MH)	300 Corporate Center Drive	Scott Depot	WV	Active
DSH510055BL	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Dermatology (CHH/MH)	1934 11th Avenue	Huntington	WV	Active
DSH510055BM	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Internal Medicine-Teays Valley (CHH/MH)	300 Corporate Center Drive	Scott Depot	WV	Active
DSH510055BN	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Neuroscience-Teays Valley (CHH/MH)	300 Corporate Center Drive	Scott Depot	WV	Active
DSH510055BP	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall OB/GYN-Teays Valley (CHH/MH)	300 Corporate Center Drive	Scott Depot	WV	Active
DSH510055BQ	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Cardiology-Teays Valley (CHH/MH) - Cardiology	300 Corporate Center Drive	Scott Depot	WV	Approved
DSH510055BR	Child	DSH	Cabell Huntington Hospital, Inc.	CHH Urodynamics - Urodynamics	1115 20th Street	Huntington	WV	Approved
DSH510055C	Child	DSH	Cabell Huntington Hospital, Inc.	CHH Family Medical Center (Merritt's Creek)	100 Meadow Pointe	Barboursville	WV	Terminated
DSH510055F	Child	DSH	Cabell Huntington Hospital, Inc.	CHH Pain Management Center	1623 13th Avenue	Huntington	WV	Active
DSH510055G	Child	DSH	Cabell Huntington Hospital, Inc.	CHH Women's & Family Medical Center (Huntington)	1115 20th Street	Huntington	WV	Terminated
DSH510055H	Child	DSH	Cabell Huntington Hospital, Inc.	Cabell Huntington Hospital Pediatrics	1115 20th Street	Huntington	WV	Terminated
DSH510055J	Child	DSH	Cabell Huntington Hospital, Inc.	Cabell Huntington Hospital Center for Lung Health	1305 Elm Street	Huntington	WV	Active
DSH510055K	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Neuroscience (CHH/MH)	1600 Medical Center Drive	Huntington	WV	Terminated
DSH510055L	Child	DSH	Cabell Huntington Hospital, Inc.	CHH Center for Wound Healing	1600 Medical Center Drive	Huntington	WV	Active
DSH510055M	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Internal Medicine Specialty (Byrd Clinical Center) (CHH/MU)	1249 15th Street	Huntington	WV	Terminated
DSH510055N	Child	DSH	Cabell Huntington Hospital, Inc.	CHH Surgery Center	1201 Hal Greer Blvd	Huntington	WV	Active
DSH510055P	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Orthopaedics (CHH/MH)	1600 Medical Center Drive	Huntington	WV	Active
DSH510055Q	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Family Medicine (CHH/MH)	1600 Medical Center Drive	Huntington	WV	Active
DSH510055R	Child	DSH	CABELL HUNTINGTON HOSPITAL, INC.	CHH/MU Surgery	1600 Medical Center Drive	Huntington	WV	Terminated
DSH510055S	Child	DSH	Cabell Huntington Hospital, Inc.	CHH/MU Peds	1600 Medical Center Drive	Huntington	WV	Terminated
DSH510055T	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Obstetrics & Gynecology (CHH/MH)	1600 Medical Center Drive	Huntington	WV	Active
DSH510055U	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Psychiatry and Behavioral Medicine (CHH/MH)	1115 20th Street	Huntington	WV	Active
DSH510055V	Child	DSH	Cabell Huntington Hospital, Inc.	Marshall Surgery (CHH/MH)	1600 Medical Center Drive	Huntington	WV	Active
DSH510055W	Child	DSH	CABELL HUNTINGTON HOSPITAL, INC.	Payne Neuro Clinic (aka Functional Neurosurgery Clinic)	1305 Elm Street	Huntington	WV	Terminated
DSH510055X	Child	DSH	CABELL HUNTINGTON HOSPITAL, INC.	Cook Eye Center	1300 3rd Avenue	HUNTINGTON	WV	Terminated
DSH510055Y	Child	DSH	Cabell Huntington Hospital, Inc.	The CHH Recovery Center	1654 13th Avenue	Huntington	WV	Active
DSH510055Z	Child	DSH	Cabell Huntington Hospital, Inc.	CHH Huntington Women's Health	1660 12th Avenue	Huntington	WV	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Blevins, Aaron C Chief Pharmacy Officer St. Mary's Medical Center 3045268250	4/8/2025 8:56 AM
Details	340B ID	Update	New Registration		DSH510055BR	4/8/2025 8:56 AM
Details	Entity Subname	Update	New Registration	CHH Urodynamics	CHH Urodynamics - Urodynamics	4/8/2025 8:56 AM
Dates	Participating Approval Date	Update	New Registration		4/8/2025 8:56:13 AM	4/8/2025 8:56 AM
Details	State	Update	New Registration	Pending	Approved	4/8/2025 8:56 AM
Dates	Signed By Date	Update	New Registration		4/8/2025 8:14:52 AM	4/8/2025 8:56 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/8/2025 8:56 AM
Addresses	Main Address	Insert	New Registration		1115 20th Street Suite 107 Huntington, WV 25703	4/7/2025 1:36 PM
Addresses	Billing Address	Insert	New Registration		Cabell Huntington Hospital, Inc. 1340 Hal Greer Blvd Huntington, WV 25701-0195	4/7/2025 1:36 PM
Addresses	Shipping Address	Insert	New Registration		Cabell Huntington Hospital, Inc. 1340 Hal Greer Blvd Huntington, WV 25701-0195	4/7/2025 1:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/7/2025 1:36 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		01690049	4/7/2025 1:36 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	4/7/2025 1:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/7/2025 1:36 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1073518007	4/7/2025 1:36 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		WV	4/7/2025 1:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/7/2025 1:36 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1217758	4/7/2025 1:36 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OH	4/7/2025 1:36 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1073518007	4/7/2025 1:36 PM
Medicaid Billing	NPI: State	Insert	New Registration		KY	4/7/2025 1:36 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1073518007	4/7/2025 1:36 PM
Medicaid Billing	NPI: State	Insert	New Registration		WV	4/7/2025 1:36 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1073518007	4/7/2025 1:36 PM
Medicaid Billing	NPI: State	Insert	New Registration		OH	4/7/2025 1:36 PM
Contacts	Authorizing Official	Insert	New Registration		Blevins, Aaron C Chief Pharmacy Officer St. Mary's Medical Center 3045268250	4/7/2025 1:36 PM
Contacts	Primary Contact	Insert	New Registration		Crutchley, Rebecca Briana 340B Coordinator Cabell Huntington Hospital 3043994690	4/7/2025 1:36 PM
Details	Assistance Received From Date	Insert	New Registration			4/7/2025 1:36 PM
Details	Assistance Received To Date	Insert	New Registration			4/7/2025 1:36 PM
Details	Last Recertification Date	Insert	New Registration			4/7/2025 1:36 PM
Details	Grant Number	Insert	New Registration			4/7/2025 1:36 PM
Details	340B ID	Insert	New Registration			4/7/2025 1:36 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/7/2025 1:36 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/7/2025 1:36 PM
Details	Medicare Provider Number	Insert	New Registration		510055	4/7/2025 1:36 PM
Details	Entity Name	Insert	New Registration		Cabell Huntington Hospital, Inc.	4/7/2025 1:36 PM
Details	NOFO Number	Insert	New Registration			4/7/2025 1:36 PM
Details	Program Code	Insert	New Registration		DSH	4/7/2025 1:36 PM
Details	Entity Subname	Insert	New Registration		CHH Urodynamics	4/7/2025 1:36 PM
Dates	Participating Approval Date	Insert	New Registration			4/7/2025 1:36 PM
Details	State	Insert	New Registration		Pending	4/7/2025 1:36 PM
Dates	Registration Date	Insert	New Registration		4/7/2025 1:36:47 PM	4/7/2025 1:36 PM
Dates	Signed By Date	Insert	New Registration			4/7/2025 1:36 PM
Dates	Start Date	Insert	New Registration			4/7/2025 1:36 PM
Terminations	Termination Comments	Insert	New Registration			4/7/2025 1:36 PM
Terminations	Termination Date	Insert	New Registration			4/7/2025 1:36 PM
Terminations	Termination Effective Date	Insert	New Registration			4/7/2025 1:36 PM
Terminations	Termination Reason	Insert	New Registration			4/7/2025 1:36 PM