340B Drug Pricing Program Database


DSH510001 WEST VIRGINIA UNIVERSITY HOSPITALS, INC. (Active) - information as of 5/9/2025 12:10:38 AM

Main Details
WEST VIRGINIA UNIVERSITY HOSPITALS, INC.
Disproportionate Share Hospital
No
DSH510001
510001


Additional Details
Active
4/24/2008
7/1/2002
4/24/2008
8/15/2024

Contacts

West Virginia University Healthcare
Justin Gibson, VP of Finance-North Region
(304) 598-4256

WVU Medicine
Karen Lynn Famoso, Enterprise Director, Compliance and Business Operations
(304) 281-2986

Addresses

1 MEDICAL CENTER DRIVE
MORGANTOWN, WV 26506

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
3/26/12 Added Medicaid #, Revised NPI# (Was 0001258000); 11/3/04 UPDATED SUBDIV NAME03/26/2012
11/3/04 UPDATED SUBDIV NAME01/14/2010
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
PA 1841271459,1265577308,1174668214,1043296619,1558342543,1790820835
WV 1841271459,1265577308,1174668214,1043296619,1558342543,1790820835
OH 1841271459,1265577308,1174668214,1043296619,1558342543,1790820835
VA 1841271459,1265577308,1174668214,1043296619,1558342543,1790820835
KY 1841271459,1265577308,1174668214,1043296619,1558342543,1790820835
Shipping Addresses

Medical Center Pharmacy
1 Medical Center Drive
Morgantown, WV 26506

WVU Hospitals dba Moutaineer Pharmacy
390 Birch Street
Morgantown, WV 26505

West Virginia University Hospitals, Inc.
Fairmont Medical Center
1325 Locust Ave
Fairmont, WV 26554-1435

West Virginia University Hospitals, Inc. d/b/a WVUH Specialty Pharmacy & Home Infusion
3040 University Ave STE 1400
Morgantown, WV 26505-3381

West Virginia United Health System Inc DBA Enterprise Pharmacy Solutions
781 Chestnut Ridge Rd Suite 600
Morgantown, WV 26505-0015
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884901/15/202004/01/2020  04/01/2020
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201001/15/202004/01/2020  04/01/2020
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750201/15/202004/01/2020  04/01/2020
Contract DetailACCREDO HEALTH GROUP INC422 GALLIMORE DAIRY RD SUITE A
GREENSBORONC2740907/15/202010/01/2020  10/01/2020
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282201/15/202004/01/2020  04/01/2020
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349201/15/202004/01/2020  04/01/2020
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624101/15/202004/01/2020 07/01/202310/01/2023
Contract DetailACCREDO HEALTH GROUP, INC.45 ROUTE 46 EAST SUITE 609
PINE BROOKNJ0705807/15/202010/01/2020  10/01/2020
Contract DetailACCREDO HEALTH GROUP, INC.11411 STRANG LINE RD STE A
LENEXAKS6621507/15/202010/01/2020  10/01/2020
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607501/18/202204/01/2022  04/01/2022
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280901/12/202404/01/2024  04/01/2024
Contract DetailALLIED HEALTH SERVICES INC.DBA ALLIED HEALTH SOLUTIONS 3040 UNIVERSITY AVE STE 1400
MORGANTOWNWV26505-338101/15/201604/01/2016 12/16/202312/16/2023
Contract DetailBELLDINA'S HEALTH MARTPHARMACY, LLC 107 S. MAIN STREET
MASONTOWNWV26542-011210/15/202001/01/2021 02/15/202502/15/2025
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526104/14/202507/01/2025  04/14/2025
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620304/14/202507/01/2025  04/14/2025
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771304/14/202507/01/2025  04/14/2025
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522604/14/202507/01/2025  04/14/2025
Contract DetailBIOSCRIP INFUSION SERVICES, LLCDBA BIOSCRIP INFUSION SERVICES 2600 MIDDLETOWN COMMONS STE 131
WHITE HALLWV26554-285904/11/201807/01/2018  04/11/2018
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/17/202201/01/2023  01/01/2023
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005601/15/202004/01/2020  04/01/2020
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621901/15/202004/01/2020  04/01/2020
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808301/19/202204/01/2022  04/01/2022
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700401/15/202004/01/2020  04/01/2020
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761701/19/202204/01/2022  04/01/2022
Contract DetailCHEAT LAKE PHARMACY  509 ASHEBROOKE SQUARE
MORGANTOWNWV2650810/31/201601/01/2017 07/01/201707/25/2017
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 6 SPRING MILL DR
MALVERNPA1935504/14/202507/01/2025  04/14/2025
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870604/07/202207/01/2022  07/01/2022
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005604/07/202207/01/2022  07/01/2022
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502801/13/202304/01/2023  04/01/2023
Contract DetailESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111201/15/202004/01/2020  04/01/2020
Contract DetailEXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313401/15/202004/01/2020  04/01/2020
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801601/15/202004/01/2020  04/01/2020
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607501/15/202004/01/2020  04/01/2020
Contract DetailGIANT EAGLE PHARMACY #0058208 GIANT STREET
MORGANTOWNWV2650110/15/202001/01/2021  01/01/2021
Contract DetailGIANT EAGLE PHARMACY #0059130 GREEN BAG ROAD
MORGANTOWNWV2650110/15/202001/01/2021  01/01/2021
Contract DetailGIANT EAGLE PHARMACY #022120160 CENTER RIDGE ROAD, SUITE 201
ROCKY RIVEROH4411610/15/202001/01/2021 09/30/202401/16/2025
Contract DetailGIANT EAGLE PHARMACY #89912500 LOVI RD
FREEDOMPA1504210/15/202001/01/2021  01/01/2021
Contract DetailGIANT EAGLE SPECIALTY PHARMACY2500 LOVI RD ROOM #101
FREEDOMPA1504204/14/202507/01/2025  04/14/2025
Contract DetailI.G.G. of AMERICA, Inc. d/b/a US Bioservices514 PROGRESS DRIVE SUITE X
LINTHICUMMD2109007/29/201310/01/2013 08/03/202208/04/2022
Contract DetailKROGER #714350 PATTESON DRIVE
MORGANTOWNWV2650510/15/202001/01/2021  01/01/2021
Contract DetailKROGER COLUMBUS CENTRAL FILL #0192270 RICKENBACKER PKWY W
COLUMBUSOH4321710/08/202401/01/2025  01/01/2025
Contract DetailKROGER PHARMACY1851 EARL CORE ROAD
MORGANTOWNWV2650510/15/202001/01/2021  01/01/2021
Contract DetailKROGER PHARMACY #774102 EMILY DR
CLARKSBURGWV26301-550110/15/202001/01/2021  01/01/2021
Contract DetailKROGER PHARMACY #813500 SUNCREST TOWN CENTRE DR.
MORGANTOWNWV2650510/15/202001/01/2021  01/01/2021
Contract DetailMARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05728 1202 NATIONAL HWY
LA VALEMD2150201/15/202004/01/2020  04/01/2020
Contract DetailMARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04102 220 NORTH 3RD ST.
OAKLANDMD2155001/15/202004/01/2020  04/01/2020
Contract DetailOPTION CARE ENTERPRISES, INC.D/B/A OPTION CARE 11403 BLUEGRASS PARKWAY
SUITE 400 		LOUISVILLEKY40299-239810/08/201901/01/2020  01/01/2020
Contract DetailOPTUM INFUSION SERVICES 201, INC.5700 DOT COM CT STE 1030
OVIEDOFL32765-340007/15/202210/01/2022 04/01/202305/03/2023
Contract DetailOPTUM INFUSION SERVICES 305, LLC4000 CHEMICAL RD STE 100
PLYMOUTH MEETINGPA1946207/15/202210/01/2022  10/01/2022
Contract DetailOPTUM INFUSION SERVICES 305, LLC15529 COLLEGE BLVD.
LENEXAKS66219-135107/15/202210/01/2022  10/01/2022
Contract DetailOPTUM INFUSION SERVICES 500, INC.4900 RIVERGRADE RD STE E120
IRWINDALECA91706-141907/15/202210/01/2022 04/01/202305/03/2023
Contract DetailOPTUM INFUSION SERVICES 550, LLC7167 E. KEMPER RD.
CINCINNATIOH4524907/15/202210/01/2022  10/01/2022
Contract DetailOPTUM INFUSION SERVICES 553, LLC6531 MERIDIEN DR SUITE 113
RALEIGHNC2761607/15/202210/01/2022  10/01/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05749 1845 MCCLELLANDTOWN RD
MASONTOWNPA1546101/15/202004/01/2020 04/01/202006/23/2020
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05700 3161 MT. MORRIS RD.
WAYNESBURGPA1537001/15/202004/01/2020 04/01/202006/23/2020
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04256 25 PITTSBURGH ST.
UNIONTOWNPA1540101/15/202004/01/2020 04/01/202006/23/2020
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04089 700 RT 819
MOUNT PLEASANTPA1566601/15/202004/01/2020 04/01/202006/23/2020
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05749 1845 MCCLELLANDTOWN RD
MASONTOWNPA1546101/19/202204/01/2022  04/01/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04256 25 PITTSBURGH ST.
UNIONTOWNPA1540101/19/202204/01/2022  04/01/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05700 3161 MT. MORRIS RD.
WAYNESBURGPA1537001/19/202204/01/2022  04/01/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05720 110 SOUTH PLEASANT AVENUE
SOMERSETPA1550110/17/202201/01/2023  01/01/2023
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.CVS PHARMACY # 17264 120 MATTHEW DR
UNIONTOWNPA1540110/17/202201/01/2023  01/01/2023
Contract DetailPIERPONT LANDING PHARMACY7000 MID ATLANTIC DR
MORGANTOWNWV2650810/15/202001/01/2021  01/01/2021
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999201/18/202204/01/2022 10/21/202210/21/2022
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514601/15/202004/01/2020  04/01/2020
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #11338 10160 INTERNATIONAL BLVD.
WEST CHESTEROH4524607/14/202110/01/2021 04/12/202504/14/2025
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738610/12/202101/01/2022  01/01/2022
Contract DetailWAL-MART PHARMACY 10-152240 JETT LN
ELKINSWV26241-554410/12/202101/01/2022  01/01/2022
Contract DetailWAL-MART PHARMACY 10-1544550 EMILY DRIVE
CLARKSBURGWV2630110/12/202101/01/2022  01/01/2022
Contract DetailWAL-MART PHARMACY 10-171432 TYGART MALL LOOP
FAIRMONTWV2655410/12/202101/01/2022  01/01/2022
Contract DetailWAL-MART PHARMACY 10-2019355 WAL-MART DR
UNIONTOWNPA1540110/12/202101/01/2022  01/01/2022
Contract DetailWAL-MART PHARMACY 10-208375 RETAIL CIRCLE
MORGANTOWNWV2650810/12/202101/01/2022  01/01/2022
Contract DetailWAL-MART PHARMACY 10-26841142 SO. BRIDGE STREET
NEW MARTINSVILLEWV2615510/12/202101/01/2022  01/01/2022
Contract DetailWAL-MART PHARMACY 10-2809100 BUCKHANNON CROSSROADS
BUCKHANNONWV2620110/12/202101/01/2022  01/01/2022
Contract DetailWAL-MART PHARMACY 10-28331 WAL-MART LANE
GRAFTONWV2635410/12/202101/01/2022  01/01/2022
Contract DetailWAL-MART PHARMACY 10-289413164 GARRETT HIGHWAY
OAKLANDMD2155010/12/202101/01/2022  01/01/2022
Contract DetailWAL-MART PHARMACY 10-32155605 UNIVERSITY TOWN CENTRE DR
GRANVILLEWV2650110/12/202101/01/2022  01/01/2022
Contract DetailWAL-MART PHARMACY 10-4372100 WAL-MART DRIVE
KINGWOODWV2653710/12/202101/01/2022  01/01/2022
Contract DetailWAL-MART PHARMACY 10-53152354 COMMERCE PARK DR.
ORLANDOFL3281910/12/202101/01/2022  01/01/2022
Contract DetailWAL-MART PHARMACY 10-53791450 MORRELL AVENUE
CONNELLSVILLEPA1542510/12/202101/01/2022  01/01/2022
Contract DetailWAL-MART PHARMACY 10-5446405 MURTHA DRIVE
WAYNESBURGPA1537010/12/202101/01/2022  01/01/2022
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/12/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #11238 615 RANDOLPH AVE.
ELKINSWV26241-395001/18/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #12266 209 N 3RD ST
OAKLANDMD2155001/18/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #12276 1240 W. MAIN ST.
BRIDGEPORTWV2633001/18/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 09343 897 CHESTNUT RIDGE RD
MORGANTOWNWV26505-270401/18/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #12277 38 VICTORY AVE.
GRAFTONWV2635401/18/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: MY PHARMACY 781 CHESTNUT RIDGE ROAD
MORGANTOWNWV2650501/18/202204/01/2022 05/12/202203/15/2023
Contract DetailWALGREEN CO.WALGREENS #18959 109 E MAIN ST
MANNINGTONWV26582-112610/13/202201/01/2023  01/01/2023
Contract DetailWALGREEN CO.WALGREENS #17700 405 FAIRMONT RD
WESTOVERWV26501-422710/13/202201/01/2023  01/01/2023
Contract DetailWALGREEN CO.WALGREENS #19258 627 FAIRMONT AVE
FAIRMONTWV26554-510310/13/202201/01/2023  01/01/2023
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 09804 180 W MAIN ST
UNIONTOWNPA15401-553701/18/202204/01/2022  04/01/2022
Contract DetailWalgreens #21423Walgreens Central Fill #21423 6275 Winchester Blvd
Canal WInchesterOH43110-653707/15/202410/01/2024  10/01/2024
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527501/18/202204/01/2022  04/01/2022
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818801/18/202204/01/2022  04/01/2022
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503301/18/202204/01/2022  04/01/2022
Contract DetailWALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275601/17/202304/01/2023  04/01/2023
Contract DetailWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616810/05/202301/01/2024  01/01/2024
Contract DetailWATERFRONT FAMILY PHARMACY215 DON KNOTTS BLVD STE 120
MORGANTOWNWV26501-673410/15/202001/01/2021  01/01/2021
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03475 300 FAIRMONT AVENUE
FAIRMONTWV2655401/15/202004/01/2020  04/01/2020
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04021 401 MARION SQUARE
FAIRMONTWV2655401/15/202004/01/2020  04/01/2020
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #10364 496 HIGH ST.
MORGANTOWNWV2650501/15/202004/01/2020  04/01/2020
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06280 1601 EARL L CORE RD.
MORGANTOWNWV2650501/15/202004/01/2020  04/01/2020
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07649 74 WEST MAIN ST.
BUCKHANNONWV2620101/15/202004/01/2020 04/01/202006/23/2020
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.CVS PHARMACY # 17066 1329 TARGET WAY
MORGANTOWNWV2650101/15/202004/01/2020  04/01/2020
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03186 701 E. MAIN STREET
CLARKSBURGWV2630101/15/202004/01/2020  04/01/2020
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #10124 1000 PINEVIEW DRIVE
MORGANTOWNWV2650501/15/202004/01/2020  04/01/2020
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05955 2 RAINBOW PLAZA
MANNINGTONWV2658201/15/202004/01/2020  04/01/2020
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01427 45 S. MINERAL ST.
KEYSERWV2672601/15/202004/01/2020 04/01/202006/23/2020
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05947 250 COURT STREET
WESTONWV2645201/15/202004/01/2020 04/01/202006/23/2020
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04136 3521 MONONGAHELA BLVD
STAR CITYWV2650501/15/202004/01/2020  04/01/2020
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01427 45 S. MINERAL ST.
KEYSERWV2672601/19/202204/01/2022  04/01/2022
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05947 250 COURT STREET
WESTONWV2645201/19/202204/01/2022  04/01/2022
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07649 74 WEST MAIN ST.
BUCKHANNONWV2620101/19/202204/01/2022  04/01/2022
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03439 505 RANDOLPH AVE
ELKINSWV2624101/19/202204/01/2022  04/01/2022
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.CVS PHARMACY # 16949 2800 MEADOWBROOK MALL
BRIDGEPORTWV2633010/17/202201/01/2023  01/01/2023
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06277 1114 LAFAYETTE AVE
MOUNDSVILLEWV2604110/17/202201/01/2023  01/01/2023
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06278 842 NATIONAL RD.
WHEELINGWV2600310/17/202201/01/2023  01/01/2023
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06281 4418 EMERSON AVE
PARKERSBURGWV2610404/14/202507/01/2025  04/14/2025
Contract DetailWHITE HALL PHARMACY, LLC.177 MIDDLETOWN RD STE 2
FAIRMONTWV26554-825404/18/202207/01/2022  07/01/2022
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH510001AChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.Cheat Lake Physicians608 Cheat RoadMorgantownWVActive
DSH510001AAChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.University Town Centre / Pediatrics6040 University Town Centre DriveMorgantownWVActive
DSH510001ABChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.University Town Centre / Internal Medicine - MGP6040 University Town Centre DriveMorgantownWVActive
DSH510001ACChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.University Town Centre / Women's Health Clinic6040 University Town Centre DriveMorgantownWVActive
DSH510001ADChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.University Town Centre / Orthopedics6040 University Town Centre DriveMorgantownWVActive
DSH510001AEChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.Spine Center at WVUH943 Maple DriveMorgantownWVActive
DSH510001AFChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.University Town Centre / Radiology6040 University Town Centre DriveMorgantownWVActive
DSH510001AGChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.STC Speciality Clinics600 Suncrest Towne Centre DriveMorgantownWVActive
DSH510001AHChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.Pediatric Neurodevelopment Clinic - Pediatric Neurodevelopment Clinic201 Bakers Ridge RoadMorgantownWVActive
DSH510001AJChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.UTC-Dermatology - UTC-Dermatology6040 University Town Centre DriveMorgantownWVActive
DSH510001AKChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.Transition Care Clinic - Transition Care Clinic1 Medical Center DriveMorgantownWVTerminated
DSH510001ALChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.Operating Room - HVI Vascular1325 Locust AvenueFairmontWVTerminated
DSH510001AMChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.Neurology/Neurosurgery Clinic - Neurology Fairmont1325 Locust AvenueFairmontWVTerminated
DSH510001ANChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.Heart Institute Clinic - HVI Cardiac Rehab1325 Locust AvenueFairmontWVActive
DSH510001APChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.ROCKEFELLER NEUROSCIENCE INSTITUTE - Neurology33 MEDICAL CENTER DRMORGANTOWNWVActive
DSH510001AQChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.ROCKEFELLER NEUROSCIENCE INSTITUTE - Neuro Clinic RNI33 MEDICAL CENTER DRMORGANTOWNWVActive
DSH510001ARChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.Radiology - Diagnostic - Radiology MRI FMT1325 Locust AvenueFairmontWVActive
DSH510001ASChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.Radiology - Diagnostic - Radiology - FMT1325 Locust AvenueFairmontWVActive
DSH510001ATChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.Emergency - ED - FMT1325 Locust AvenueFairmontWVActive
DSH510001AUChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.Operating Room - OR Endo FMT1325 Locust AvenueFairmontWVActive
DSH510001AVChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.Sleep Disorders-FRMT - Sleep Lab1325 Locust AvenueFairmontWVActive
DSH510001AWChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.UTC - Orthopedics Gold - Orthopedics6050 University Town Centre DriveMorgantownWVActive
DSH510001AXChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.WVUH PET64 Medical Center DriveMorgantownWVActive
DSH510001BChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.Heart Institute1 Medical Center DriveMorgantownWVTerminated
DSH510001CChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.WVUH-Sleep Lab205 Baker's Ridge RoadMorgantownWVActive
DSH510001DChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.WVUH-Sports Medicine Clinic943 Maple DriveMorgantownWVTerminated
DSH510001EChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.WVUH-Pain Management1075 Van Voorhis RoadMorgantownWVActive
DSH510001FChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.WVUH-Wound Care Center1 Medical Center DriveMorgantownWVTerminated
DSH510001GChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.WVUH-Women's Health Clinic1 Medical Center DriveMorgantownWVTerminated
DSH510001HChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.WVUH-Surgical Specialty Clinic1 Medical Center DriveMorgantownWVTerminated
DSH510001JChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.WVUH-Medicine Suite 3 Clinic1 Medical Center DriveMorgantownWVTerminated
DSH510001KChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.WVUH-MGP Clinic1 Medical Center DriveMorgantownWVTerminated
DSH510001LChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.WVUH - Medical Specialty Clinic1 Medical Center DriveMorgantownWVTerminated
DSH510001MChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.WVUH-Pediatrics1 Medical Center DriveMorgantownWVTerminated
DSH510001NChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.WVUH-Orthopedics Clinic1 Medical Center DriveMorgantownWVTerminated
DSH510001PChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.WVUH-ENT Clinic1 Medical Center DriveMorgantownWVTerminated
DSH510001QChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.WVUH - Neurology/Neurosurgery Clinic1 Medical Center DriveMorgantownWVTerminated
DSH510001RChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.WVUH-Opthalmology Clinic1 Medical Center DriveMorgantownWVActive
DSH510001SChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.UTC - Family Medicine6040 University Town Centre DriveMorgantownWVActive
DSH510001TChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.WVUH - Breast Care Center1 Medical Center DriveMorgantownWVTerminated
DSH510001UChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.WVUH - Radiation Oncology Clinic1 Medical Center DriveMorgantownWVTerminated
DSH510001VChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.WVUH - Cancer Clinic1 Medical Center DriveMorgantownWVTerminated
DSH510001WChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.Chestnut Ridge Day Hospital Clinic3600 Collins Ferry RoadMorgantownWVActive
DSH510001XChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.Electroshock Therapy930 Chestnut Ridge RoadMorgantownWVActive
DSH510001YChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.Radiation Oncology-Fairmont1325 Locust AvenueFairmontWVActive
DSH510001ZChildDSHWEST VIRGINIA UNIVERSITY HOSPITALS, INC.Center for Joint Replacement Clinic1075 Van Voorhis RdMorgantownWVTerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressDeleteChange RequestSafecor Health, LLC 4060 Business Park Drive Columbus, OH 43204 10/28/2024 1:39 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestGibson, Justin VP of Finance-North Region West Virginia University Healthcare 3045984085Gibson, Justin VP of Finance-North Region West Virginia University Healthcare 304598425610/21/2024 4:34 PM
AddressesShipping AddressInsertGroup Change Request West Virginia United Health System Inc DBA Enterprise Pharmacy Solutions 781 Chestnut Ridge Rd Suite 600 Morgantown, WV 26505-001510/18/2024 10:17 AM
DetailsLast Recertification DateUpdateRecertification8/17/2023 4:29:09 PM8/15/2024 7:56:41 AM8/15/2024 7:56 AM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request0001258000 (WV) 6/7/2024 7:55 PM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request1007552330001 (PA) 6/7/2024 7:55 PM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request330405100 (MD) 6/7/2024 7:55 PM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request9354756 (OH) 6/7/2024 7:55 PM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request1841271459 (VA) 6/7/2024 7:55 PM
Medicaid BillingNPI: NumberDeleteGroup Change Request1841271459 (MD) 6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 18412714596/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request KY6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 12655773086/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request WV6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 11746682146/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request WV6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 10432966196/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request WV6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 15583425436/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request WV6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 17908208356/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request WV6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 12655773086/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request OH6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 11746682146/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request OH6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 10432966196/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request OH6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 15583425436/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request OH6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 17908208356/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request OH6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 12655773086/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request PA6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 11746682146/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request PA6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 10432966196/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request PA6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 15583425436/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request PA6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 17908208356/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request PA6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 12655773086/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request VA6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 11746682146/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request VA6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 10432966196/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request VA6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 15583425436/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request VA6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 17908208356/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request VA6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 12655773086/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request KY6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 11746682146/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request KY6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 10432966196/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request KY6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 15583425436/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request KY6/7/2024 7:55 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 17908208356/7/2024 7:55 PM
Medicaid BillingNPI: StateInsertGroup Change Request KY6/7/2024 7:55 PM
AddressesShipping AddressInsertChange Request West Virginia University Hospitals, Inc. d/b/a WVUH Specialty Pharmacy & Home Infusion 3040 University Ave STE 1400 Morgantown, WV 26505-338112/6/2023 8:08 AM
DetailsLast Recertification DateUpdateRecertification9/6/2022 10:50:48 AM8/17/2023 4:29:09 PM8/17/2023 4:29 PM
DetailsLast Recertification DateUpdateRecertification8/24/2021 11:40:09 AM9/6/2022 10:50:48 AM9/6/2022 10:50 AM
ContactsPrimary ContactUpdateGroup Change RequestMay, Barbra Sue Enterprise Manager, 340B Program WVU Medicine 3042909830Famoso, Karen Lynn Enterprise Director, Compliance and Business Operations WVU Medicine 30428129865/25/2022 7:22 AM
ContactsPrimary ContactUpdateGroup Change RequestFamoso, Karen Lynn Enterprise Director, Compliance and Business Operations WVU Medicine 3042812986May, Barbra Sue Enterprise Manager, 340B Program WVU Medicine 30429098301/24/2022 7:43 AM
DetailsLast Recertification DateUpdateRecertification9/10/2020 9:48:57 AM8/24/2021 11:40:09 AM8/24/2021 11:40 AM
ContactsAuthorizing OfficialUpdateChange RequestMcCoy, Melissa D Chief Financial Officer WVU Hospitals 3045984554Gibson, Justin VP of Finance-North Region West Virginia University Healthcare 304598408510/20/2020 9:19 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2020 9:48 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075523300019/10/2020 9:48 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/10/2020 9:48 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2020 9:48 AM
Medicaid BillingMedicaid: NumberInsertRecertification 3304051009/10/2020 9:48 AM
Medicaid BillingMedicaid: StateInsertRecertification MD9/10/2020 9:48 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2020 9:48 AM
Medicaid BillingMedicaid: NumberInsertRecertification 93547569/10/2020 9:48 AM
Medicaid BillingMedicaid: StateInsertRecertification OH9/10/2020 9:48 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/10/2020 9:48 AM
Medicaid BillingMedicaid: NumberInsertRecertification 18412714599/10/2020 9:48 AM
Medicaid BillingMedicaid: StateInsertRecertification VA9/10/2020 9:48 AM
Medicaid BillingNPI: NumberDeleteRecertification1841271459 ( ) 9/10/2020 9:48 AM
Medicaid BillingNPI: NumberInsertRecertification 18412714599/10/2020 9:48 AM
Medicaid BillingNPI: StateInsertRecertification PA9/10/2020 9:48 AM
Medicaid BillingNPI: NumberInsertRecertification 18412714599/10/2020 9:48 AM
Medicaid BillingNPI: StateInsertRecertification MD9/10/2020 9:48 AM
Medicaid BillingNPI: NumberInsertRecertification 18412714599/10/2020 9:48 AM
Medicaid BillingNPI: StateInsertRecertification WV9/10/2020 9:48 AM
Medicaid BillingNPI: NumberInsertRecertification 18412714599/10/2020 9:48 AM
Medicaid BillingNPI: StateInsertRecertification OH9/10/2020 9:48 AM
Medicaid BillingNPI: NumberInsertRecertification 18412714599/10/2020 9:48 AM
Medicaid BillingNPI: StateInsertRecertification VA9/10/2020 9:48 AM
DetailsLast Recertification DateUpdateRecertification8/20/2019 10:28:36 AM9/10/2020 9:48:57 AM9/10/2020 9:48 AM
AddressesShipping AddressInsertChange Request Safecor Health, LLC 4060 Business Park Drive Columbus, OH 432048/5/2020 8:22 AM
AddressesShipping AddressInsertChange Request West Virginia University Hospitals, Inc. Fairmont Medical Center 1325 Locust Ave Fairmont, WV 26554-14356/22/2020 6:41 AM
ContactsPrimary ContactUpdateProfile Change RequestFamoso, Karen Lynn Regional Director of Pharmacy Camden Clark Medical Center 3042214534Famoso, Karen Lynn Enterprise Director, Compliance and Business Operations WVU Medicine 30428129866/12/2020 3:21 PM
ContactsPrimary ContactUpdateChange RequestStephens, Amy Director WVU Hospitals 3045984877Famoso, Karen Lynn Regional Director of Pharmacy Camden Clark Medical Center 30422145345/19/2020 10:47 AM
DetailsLast Recertification DateUpdateRecertification8/22/2018 5:11:08 PM8/20/2019 10:28:36 AM8/20/2019 10:28 AM
DetailsLast Recertification DateUpdateRecertification11/16/2017 4:24:36 PM8/22/2018 5:11:08 PM8/22/2018 5:11 PM
ContactsPrimary ContactUpdateChange RequestWOODWARD, CAROL DIRECTOR OF PHARMACY WVU Hospitals 3045984148Stephens, Amy Director WVU Hospitals 30459848774/11/2018 7:25 AM
DetailsLast Recertification DateUpdateRecertification8/29/2016 12:00:00 AM11/16/2017 4:24:36 PM11/16/2017 4:24 PM
ContactsPrimary ContactUpdateRecertificationWOODWARD, CAROL DIRECTOR OF PHARMACY 3045984148WOODWARD, CAROL DIRECTOR OF PHARMACY WVU Hospitals 304598414811/16/2017 4:24 PM
ContactsAuthorizing OfficialInsertAO Change Request McCoy, Melissa D Chief Financial Officer WVU Hospitals 304598455411/13/2017 7:17 AM
AddressesMain AddressInsert   1 MEDICAL CENTER DRIVE MORGANTOWN, WV 265067/25/2017 12:21 PM
AddressesShipping AddressInsert  Medical Center Pharmacy 1 Medical Center Drive Morgantown, WV 265067/25/2017 12:21 PM
AddressesShipping AddressInsert  WVU Hospitals dba Moutaineer Pharmacy 390 Birch Street Morgantown, WV 265057/25/2017 12:21 PM
ContactsPrimary ContactInsert  WOODWARD, CAROL DIRECTOR OF PHARMACY 30459841487/25/2017 12:21 PM
DetailsLast Recertification DateUpdate 9/1/2015 12:00:00 AM8/29/2016 12:00:00 AM8/29/2016 5:51 PM
DetailsLast Recertification DateUpdate 9/3/2014 12:00:00 AM9/1/2015 12:00:00 AM9/1/2015 4:48 PM
DetailsLast Recertification DateUpdate 9/12/2013 12:00:00 AM9/3/2014 12:00:00 AM9/3/2014 2:12 PM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/12/2013 12:00:00 AM9/12/2013 8:10 PM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/17/2012 8:53 AM
DetailsEntity SubnameUpdate MEDICAL CENTER PHARMACY 5/17/2012 8:53 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False3/26/2012 3:38 PM
Medicaid BillingMedicaid: NumberInsert  00012580003/26/2012 3:38 PM
Medicaid BillingMedicaid: StateInsert  WV3/26/2012 3:38 PM
Medicaid BillingNPI: NumberUpdate 000125800018412714593/26/2012 3:38 PM
DetailsComments PublicInsert  3/26/12 Added Medicaid #, Revised NPI# (Was 0001258000); 11/3/04 UPDATED SUBDIV NAME3/26/2012 3:38 PM
DetailsLast Recertification DateInsert   1/14/2010 2:21 PM
DetailsGrant NumberInsert   1/14/2010 2:21 PM
Details340B IDInsert  DSH5100011/14/2010 2:21 PM
DetailsIs Authorizing Official EHB DataInsert   1/14/2010 2:21 PM
DatesLast Date That 340B Drugs PurchasedInsert   1/14/2010 2:21 PM
DetailsMedicare Provider NumberInsert  5100011/14/2010 2:21 PM
DetailsEntity NameInsert  WEST VIRGINIA UNIVERSITY HOSPITALS, INC.1/14/2010 2:21 PM
DetailsProgram CodeInsert  DSH1/14/2010 2:21 PM
DetailsEntity SubnameInsert  MEDICAL CENTER PHARMACY1/14/2010 2:21 PM
DatesParticipating Approval DateInsert  4/24/2008 12:00:00 AM1/14/2010 2:21 PM
DetailsStateInsert  Active1/14/2010 2:21 PM
DatesRegistration DateInsert  4/24/2008 12:00:00 AM1/14/2010 2:21 PM
DatesSigned By DateInsert   1/14/2010 2:21 PM
DatesStart DateInsert  7/1/2002 12:00:00 AM1/14/2010 2:21 PM
TerminationsTermination CommentsInsert   1/14/2010 2:21 PM
TerminationsTermination DateInsert   1/14/2010 2:21 PM
TerminationsTermination Effective DateInsert   1/14/2010 2:21 PM
TerminationsTermination ReasonInsert   1/14/2010 2:21 PM
DetailsComments PublicInsert  11/3/04 UPDATED SUBDIV NAME1/14/2010 2:21 PM
Medicaid BillingNPI: NumberInsert  00012580004/24/2008 1:36 PM