Covered Entity Details

CAH511313-00 BOONE MEMORIAL HOSPITAL (Active) - information as of 4/25/2025 12:00:44 AM

Main Details

Name

BOONE MEMORIAL HOSPITAL

Subdivision Name

Type

Critical Access Hospital

Rural

340B ID

CAH511313-00

Medicare Provider Number

511313

Additional Details

Current Program Status

Active

Registration Date

11/29/2010

Participating Start Date

1/1/2011

Participating Approval Date

12/2/2010

Last Recertification Date

9/5/2024

Contacts

Authorizing Official

Boone Memorial Hospital Inc.
Virgil Lee Underwood, CEO
(304) 369-1230 Ext: 5507

Primary Contact

Boone Memorial Hospital
Angela Christian, Executive Director of Ancillary Services
(304) 369-1230 Ext: 5517

Addresses

Street Address

701 Madison Avenue
MADISON, WV 25130

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?
No

Shipping Addresses

Shipping Address 1

Boone Memorial Hospital Inc.
701 Madison Avenue
Madison, WV 25130

Shipping Address 2

BMH Outpatient Pharmacy
697 Madison Avenue
Madison, WV 25130

Shipping Address 3

BMH Comfort Pharmacy
6952 Coal River Road
Suite A
Comfort, WV 25049

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ARACOMA DRUG CO OF CHAPMANVIL	772 MAIN STREET	BOX 1570	CHAPMANVILLE	WV	25508-1570	07/07/2015	10/01/2015	03/12/2021	07/14/2021
Contract Detail	ARACOMA DRUG CO OF CHAPMANVILLE	772 MAIN ST		CHAPMANVILLE	WV	25508-4533	03/12/2021	03/12/2021		03/15/2021
Contract Detail	CHAPMANVILLE PHARMACY INC	289 CRAWLEY CREEK RD	CHAPMANVILLE PHARMACY INC	CHAPMANVILLE	WV	25508-7403	10/01/2014	01/01/2015	06/28/2023	08/09/2023
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/14/2023	10/01/2023		10/01/2023
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/14/2023	10/01/2023		10/01/2023
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	01/10/2018	04/01/2018		01/10/2018
Contract Detail	DANVILLE PHARMACY	2008 SMOOT AVENUE		DANVILLE	WV	25053	06/26/2019	06/26/2019		06/26/2019
Contract Detail	FAMILY LIFE PHARMACY	FAMILY LIFE PHARMACY	21189 COAL RIVER RD	COMFORT	WV	25049	07/14/2021	10/01/2021	08/19/2023	10/03/2023
Contract Detail	HARTS PHARMACY, INC.	217 HARTS STREET	P.O. BOX 250	HARTS	WV	25524-0250	04/28/2020	07/01/2020	09/11/2023	10/03/2023
Contract Detail	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	04/15/2024	07/01/2024		07/01/2024
Contract Detail	KROGER PHARMACY #668	25 HOLDEN ROAD	P.O. BOX 1264	MOUNT GAY	WV	25637	04/28/2020	07/01/2020		07/01/2020
Contract Detail	KROGER PHARMACY #817	3265 SMOOT AVE		DANVILLE	WV	25053	03/01/2013	04/01/2013		03/28/2013
Contract Detail	LARRY'S DRIVE-IN PHARMACY INC		313 MADISON AVE	MADISON	WV	25130	01/11/2013	04/01/2013	07/13/2018	07/13/2018
Contract Detail	MADISON FAMILY PHARMACY, LLC	313 MADISON AVENUE		MADISON	WV	25130-1510	04/11/2017	07/01/2017	07/13/2018	07/13/2018
Contract Detail	MEDICAP PHARMACY	# 8217	2008 SMOOT AVENUE P.O. BOX 1085	DANVILLE	WV	25053-1085	02/27/2013	04/01/2013	06/26/2019	07/14/2021
Contract Detail	MILLER BROTHERS PHARMACY	271 MAIN ST		MADISON	WV	25130-1219	07/13/2018	10/01/2018		10/01/2018
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	01/10/2018	04/01/2018	10/10/2022	10/10/2022
Contract Detail	RITE AID OF WEST VIRGINIA, INC.	RITE AID #1289	406 SMOOT AVENUE P.O. BOX 286	DANVILLE	WV	25053	10/19/2012	10/19/2012	02/16/2018	02/20/2018
Contract Detail	RITE AID OF WEST VIRGINIA, INC.	RITE AID #953	69 LEWIS STREET	WHITESVILLE	WV	25209	10/19/2012	10/19/2012	02/16/2018	02/20/2018
Contract Detail	RITE AID OF WEST VIRGINIA, INC.	RITE AID #2460	901 MAIN STREET P.O. BOX 4547	CHAPMANVILLE	WV	25508	10/19/2012	10/19/2012	02/16/2018	02/20/2018
Contract Detail	VAN PHARMACY, INC	19024 POND FORK ROAD	PO BOX 450	VAN	WV	25206	04/06/2018	07/01/2018		04/06/2018
Contract Detail	VAN PROFESSIONAL PHARMACY	19024 POND FORK ROAD	P.O. BOX 450	VAN	WV	25206	07/07/2015	10/01/2015	07/01/2018	07/14/2021
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/28/2020	07/01/2020		07/01/2020
Contract Detail	WAL-MART PHARMACY 10-2610	77 NORMAN MORGAN BLVD		LOGAN	WV	25601	04/28/2020	07/01/2020		07/01/2020
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/28/2020	07/01/2020		07/01/2020
Contract Detail	WALGREEN CO.	WALGREENS #17413	1662 SMOOT AVE PO BOX 286	DANVILLE	WV	25053-0286	02/20/2018	02/20/2018		02/20/2018
Contract Detail	WALGREEN CO.	WALGREENS #17792	901 MAIN ST	CHAPMANVILLE	WV	25508-4547	02/20/2018	02/20/2018		02/20/2018
Contract Detail	WALGREEN CO.	WALGREENS #17559	69 LEWIS ST.	WHITESVILLE	WV	25209	02/20/2018	02/20/2018		02/20/2018
Contract Detail	WALGREEN CO.	WALGREENS #17782	8315 COURT AVE	HAMLIN	WV	25523-1332	07/14/2022	10/01/2022	11/16/2023	11/16/2023
Contract Detail	WALGREEN CO.	WALGREENS #17504	164 HOLDEN RD	MOUNT GAY	WV	25637	07/14/2022	10/01/2022	02/17/2025	02/21/2025
Contract Detail	WALGREEN CO.	WALGREENS #18275	28 MAIN AVE PO BOX 4547	LOGAN	WV	25601-3331	07/14/2022	10/01/2022		10/01/2022
Contract Detail	Walgreens #21420	Walgreens Central Fill #21420	8440 Times Dispatch Blvd Ste. 400	Mechanicsville	VA	23116	07/10/2023	10/01/2023		10/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	01/10/2018	04/01/2018	10/15/2021	01/12/2022
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/10/2018	04/01/2018		01/10/2018
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/10/2018	04/01/2018		01/10/2018
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/10/2018	04/01/2018		01/10/2018
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/13/2023	04/01/2023		04/01/2023
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/13/2023	01/01/2024		01/01/2024
Contract Detail	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04207	4205 MACCORKLE AVE.	CHARLESTON	WV	25304	07/14/2023	10/01/2023		10/01/2023
Contract Detail	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06306	201 MACCORKLE AVE.	SAINT ALBANS	WV	25177	07/14/2023	10/01/2023		10/01/2023
Contract Detail	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04244	121 10TH ST.	DUNBAR	WV	25064	07/14/2023	10/01/2023		10/01/2023
Contract Detail	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #2148	885 OAKWOOD ROAD	CHARLESTON	WV	25314	07/14/2023	10/01/2023		10/01/2023
Contract Detail	WEST VIRGINIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16609	30 RHL BLVD	SOUTH CHARLESTON	WV	25309	07/14/2023	10/01/2023		10/01/2023

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH511313-01	Child	CAH	BOONE MEMORIAL HOSPITAL	BOONE MEMORIAL HOSPITAL MEDICAL CLINIC	660 South Main Street Suite A	MADISON	WV	Active
CAH511313-02	Child	CAH	BOONE MEMORIAL HOSPITAL	BOONE MEMORIAL HOSPITAL RURAL HEALTH CLINIC	697 Madison Avenue	MADISON	WV	Active
CAH511313-03	Child	CAH	BOONE MEMORIAL HOSPITAL	Boone Memorial Hospital Specialty Clinic - Dermatology	300 Fourth Street	Danville	WV	Active
CAH511313-04	Child	CAH	BOONE MEMORIAL HOSPITAL	BMH Comfort Clinic - Rural Health Clinic	6952 Coal River Road	Comfort	WV	Active
CAH511313-05	Child	CAH	BOONE MEMORIAL HOSPITAL	BMH Walk-in Clinic - Rural Health Clinic	300 Fourth Street	Danville	WV	Active
CAH511313-06	Child	CAH	BOONE MEMORIAL HOSPITAL	BMH Specialty Clinic - Provider Based Clinic	712 Madison Avenue	Madison	WV	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/24/2023 1:57:20 PM	9/5/2024 10:02:52 AM	9/5/2024 10:02 AM
Addresses	Shipping Address	Insert	Recertification		BMH Comfort Pharmacy 6952 Coal River Road Suite A Comfort, WV 25049	8/24/2023 1:57 PM
Details	Last Recertification Date	Update	Recertification	9/19/2022 2:20:07 PM	8/24/2023 1:57:20 PM	8/24/2023 1:57 PM
Details	Last Recertification Date	Update	Recertification	9/21/2021 6:42:09 AM	9/19/2022 2:20:07 PM	9/19/2022 2:20 PM
Details	Last Recertification Date	Update	Recertification	9/11/2020 4:50:45 PM	9/21/2021 6:42:09 AM	9/21/2021 6:42 AM
Details	Last Recertification Date	Update	Recertification	9/12/2019 4:11:24 PM	9/11/2020 4:50:45 PM	9/11/2020 4:50 PM
Contacts	Primary Contact	Update	Change Request	FOSTER, ROBERT EXECUTIVE DIRECTOR OF PHARMACY SERVICES Boone Memorial Hospital 3043691230-6403	Christian, Angela Executive Director of Ancillary Services Boone Memorial Hospital 3043691230-5517	10/10/2019 6:37 AM
Details	Last Recertification Date	Update	Recertification	8/29/2018 2:26:08 PM	9/12/2019 4:11:24 PM	9/12/2019 4:11 PM
Details	Last Recertification Date	Update	Recertification	11/7/2017 8:38:41 AM	8/29/2018 2:26:08 PM	8/29/2018 2:26 PM
Contacts	Authorizing Official	Update	AO Change Request	FOXX, RANDELL Davis CFO Boone Memorial Hospital, Inc. 3043691230-5508	Underwood, Virgil Lee CEO Boone Memorial Hospital Inc. 3043691230-5507	8/28/2018 12:24 PM
Addresses	Shipping Address	Insert	Change Request		Boone Memorial Hospital Inc. 701 Madison Avenue Madison, WV 25130	6/13/2018 8:08 AM
Addresses	Shipping Address	Insert	Change Request		BMH Outpatient Pharmacy 697 Madison Avenue Madison, WV 25130	6/13/2018 8:08 AM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	11/7/2017 8:38:41 AM	11/7/2017 8:38 AM
Contacts	Primary Contact	Update		FOSTER, ROBERT EXECUTIVE DIRECTOR OF PHARMACY SERVICES 3043691230-6403	FOSTER, ROBERT EXECUTIVE DIRECTOR OF PHARMACY SERVICES Boone Memorial Hospital 3043691230-6403	10/23/2017 1:08 PM
Contacts	Authorizing Official	Update		FOXX, RANDELL CFO 3043691230-5508	FOXX, RANDELL Davis CFO Boone Memorial Hospital, Inc. 3043691230-5508	10/23/2017 1:05 PM
Contacts	Authorizing Official	Insert			FOXX, RANDELL CFO 3043691230-5508	4/11/2017 8:56 AM
Contacts	Primary Contact	Insert			FOSTER, ROBERT EXECUTIVE DIRECTOR OF PHARMACY SERVICES 3043691230-6403	8/10/2016 1:02 PM
Addresses	Main Address	Insert			701 MADISON AVENUE MADISON, WV 25130	8/10/2016 11:31 AM
Details	Last Recertification Date	Update		8/10/2015 12:00:00 AM	8/10/2016 12:00:00 AM	8/10/2016 11:31 AM
Details	Last Recertification Date	Update		9/4/2014 12:00:00 AM	8/10/2015 12:00:00 AM	8/10/2015 12:36 PM
Details	Last Recertification Date	Update		8/19/2013 10:29:02 AM	9/4/2014 12:00:00 AM	9/4/2014 10:41 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/19/2013 10:29:02 AM	8/19/2013 10:29 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	6/1/2012 7:49 AM
Details	Last Recertification Date	Insert				12/2/2010 3:01 PM
Details	Grant Number	Insert				12/2/2010 3:01 PM
Details	340B ID	Insert			CAH511313-00	12/2/2010 3:01 PM
Details	Is Authorizing Official EHB Data	Insert				12/2/2010 3:01 PM
Dates	Last Date That 340B Drugs Purchased	Insert				12/2/2010 3:01 PM
Details	Medicare Provider Number	Insert			511313	12/2/2010 3:01 PM
Details	Entity Name	Insert			BOONE MEMORIAL HOSPITAL	12/2/2010 3:01 PM
Details	Program Code	Insert			CAH	12/2/2010 3:01 PM
Details	Entity Subname	Insert				12/2/2010 3:01 PM
Dates	Participating Approval Date	Insert			12/2/2010 12:00:00 AM	12/2/2010 3:01 PM
Details	State	Insert			Active	12/2/2010 3:01 PM
Dates	Registration Date	Insert			11/29/2010 12:00:00 AM	12/2/2010 3:01 PM
Dates	Signed By Date	Insert			11/30/2010 12:00:00 AM	12/2/2010 3:01 PM
Dates	Start Date	Insert			1/1/2011 12:00:00 AM	12/2/2010 3:01 PM
Terminations	Termination Comments	Insert				12/2/2010 3:01 PM
Terminations	Termination Date	Insert				12/2/2010 3:01 PM
Terminations	Termination Effective Date	Insert				12/2/2010 3:01 PM
Terminations	Termination Reason	Insert				12/2/2010 3:01 PM