Covered Entity Details

DSH510038A STONEWALL JACKSON MEMORIAL HOSPITAL (Terminated) - information as of 5/30/2025 6:46:51 PM

Main Details

Name

STONEWALL JACKSON MEMORIAL HOSPITAL

Subdivision Name

Weston Pulmonary and Medical

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH510038A

Medicare Provider Number

510038

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/1/2018

Participating Start Date

1/1/2019

Participating Approval Date

10/3/2018

Last Recertification Date

8/18/2023

Termination Date
Termination Reason

10/1/2024
Business decision by the Covered Entity

Contacts

Authorizing Official

Stonewall Jackson Memorial Hospital
Kevin Stalnaker, Chief Administrative Officer
(304) 269-8152

Primary Contact

Mon Health Stonewall Jackson memorial Hospital
Joe P Second, Sr Dir Operations
(304) 269-8149

Addresses

Street Address

66 Hospital Plaza
Suite 104
Weston, WV 26452

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participating from effective date (1/1/2013) until terminated effective date (10/01/2018), reinstatement effective date (01/01/2019)	10/02/2018

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	0001417000	1477559433

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
DSH510038A	Child	DSH	STONEWALL JACKSON MEMORIAL HOSPITAL	Weston Pulmonary and Medical	66 Hospital Plaza	Weston	WV	Terminated
DSH510038C	Child	DSH	STONEWALL JACKSON MEMORIAL HOSPITAL	Lively Healthcare/Lively Clinic	533 Hackers Creek Road	Jane Lew	WV	Terminated
DSH510038D	Child	DSH	STONEWALL JACKSON MEMORIAL HOSPITAL	Ronald Pearson, M.D.	25 Garton Plaza	Weston	WV	Active
DSH510038E	Child	DSH	STONEWALL JACKSON MEMORIAL HOSPITAL	Mountaineer Healthcare for Women	66 Hospital Plaza	Weston	WV	Active
DSH510038F	Child	DSH	STONEWALL JACKSON MEMORIAL HOSPITAL	Weston ENT and Audiology/ENT Clinic	456 Suite B Marketplace Mall	Weston	WV	Terminated
DSH510038G	Child	DSH	STONEWALL JACKSON MEMORIAL HOSPITAL	Mon Health Primary Care - Weston	456 Market Place Mall C	Weston	WV	Active
DSH510038H	Child	DSH	STONEWALL JACKSON MEMORIAL HOSPITAL	Weston Orthopedics and Sports Medicine	29 Hospital Plaza	Weston	WV	Active
DSH510038J	Child	DSH	STONEWALL JACKSON MEMORIAL HOSPITAL	Stonewall Urology	230 Hospital Plaza	Weston	WV	Active
DSH510038K	Child	DSH	STONEWALL JACKSON MEMORIAL HOSPITAL	Brian Hornsby, D.O.	251 West Second Street	Weston	WV	Terminated
DSH510038L	Child	DSH	STONEWALL JACKSON MEMORIAL HOSPITAL	Paula Galloway, D.O.	66 Hospital Plaza, Suite 102	Weston	WV	Terminated
DSH510038M	Child	DSH	STONEWALL JACKSON MEMORIAL HOSPITAL	Mon Health Pulmonology	29 Hospital Plaza, Suite B	Weston	WV	Active
DSH510038N	Child	DSH	STONEWALL JACKSON MEMORIAL HOSPITAL	STONEWALL PEDIATRICS/MISTRY	251 WEST SECOND STREET	WESTON	WV	Terminated
DSH510038P	Child	DSH	STONEWALL JACKSON MEMORIAL HOSPITAL	Dana Pauley Persinger, D.O./Persinger Clinic - Family Medicine	25 Garton Plaza	Weston	WV	Terminated
DSH510038Q	Child	DSH	STONEWALL JACKSON MEMORIAL HOSPITAL	Stonewall Medical Group	251 West Second Street	Weston	WV	Active
DSH510038R	Child	DSH	STONEWALL JACKSON MEMORIAL HOSPITAL	Stonewall Heart and Vascular Clinic - Heart and Vascular	66 Hospital Plaza	Weston	WV	Active
DSH510038S	Child	DSH	STONEWALL JACKSON MEMORIAL HOSPITAL	Mon Health Primary Care - Garton Plaza - Primary Care	25 Garton Plaza	Weston	WV	Active
DSH510038T	Child	DSH	STONEWALL JACKSON MEMORIAL HOSPITAL	Mon Health Primary Care- Buckhannon - primary care	132 Cinema Circle	Buckhannon	WV	Active
DSH510038U	Child	DSH	STONEWALL JACKSON MEMORIAL HOSPITAL	Mon Health Podiatry - Mon Health Podiatry	66 Hospital Plaza	Weston	WV	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		6/30/2024 12:00:00 AM	7/10/2024 11:19 AM
Details	State	Update	Termination Request	Active	To Be Terminated	7/10/2024 11:19 AM
Terminations	Termination Date	Update	Termination Request		10/1/2024 12:00:00 AM	7/10/2024 11:19 AM
Terminations	Termination Effective Date	Update	Termination Request		7/1/2024 12:00:00 AM	7/10/2024 11:19 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	7/10/2024 11:19 AM
Contacts	Primary Contact	Update	PC Change Request	Smith, Heather E Director of Pharmacy Stonewall Jackson Memorial Hospital 3042698092	Second, Joe P Sr Dir Operations Mon Health Stonewall Jackson memorial Hospital 3042698149	1/8/2024 7:02 AM
Details	Last Recertification Date	Update	Recertification	8/24/2022 7:51:40 AM	8/18/2023 7:17:28 AM	8/18/2023 7:17 AM
Contacts	Primary Contact	Update	Profile Change Request	Smith, Heather E Director of Pharmacy Stonewall Jackson Memorial Hospital 3042698091	Smith, Heather E Director of Pharmacy Stonewall Jackson Memorial Hospital 3042698092	7/13/2023 2:24 PM
Contacts	Primary Contact	Update	Group Change Request	Pope, John Edward Director of Pharmacy Stonewall Jackson Memorial Hospital 3042698092	Smith, Heather E Director of Pharmacy Stonewall Jackson Memorial Hospital 3042698091	7/13/2023 2:13 PM
Contacts	Authorizing Official	Update	Profile Change Request	Stalnaker, Kevin Assistant Chief Executive Officer Stonewall Jackson Memorial Hospital 3042698152	Stalnaker, Kevin Chief Administrative Officer Stonewall Jackson Memorial Hospital 3042698152	6/12/2023 3:43 PM
Contacts	Signed By	Update	Profile Change Request	Stalnaker, Kevin Assistant Chief Executive Officer Stonewall Jackson Memorial Hospital 3042698152	Stalnaker, Kevin Chief Administrative Officer Stonewall Jackson Memorial Hospital 3042698152	6/12/2023 3:43 PM
Details	Last Recertification Date	Update	Recertification	8/24/2021 2:17:03 PM	8/24/2022 7:51:40 AM	8/24/2022 7:51 AM
Addresses	Main Address	Update	Change Request	66 Hospital Plaza Weston, WV 26452	66 Hospital Plaza Suite 104 Weston, WV 26452	4/12/2022 2:14 PM
Details	Entity Subname	Update	Change Request	Weston Pulmonary and Medical/Mahmoud Clinic Pulmonology	Weston Pulmonary and Medical	4/12/2022 2:14 PM
Details	Last Recertification Date	Update	Recertification	8/28/2020 2:41:48 PM	8/24/2021 2:17:03 PM	8/24/2021 2:17 PM
Medicaid Billing	NPI: State	Update	Recertification		WV	8/28/2020 2:41 PM
Details	Last Recertification Date	Update	Recertification	8/19/2019 3:49:39 PM	8/28/2020 2:41:48 PM	8/28/2020 2:41 PM
Details	Last Recertification Date	Update	Recertification		8/19/2019 3:49:39 PM	8/19/2019 3:49 PM
Details	State	Update		Approved	Active	1/1/2019 12:05 AM
Contacts	Signed By	Update	Reinstatement	Arbogast, Dodie Controller 3042698050	Stalnaker, Kevin Assistant Chief Executive Officer Stonewall Jackson Memorial Hospital 3042698152	10/3/2018 12:46 PM
Dates	Participating Approval Date	Update	Reinstatement		10/3/2018 12:46:21 PM	10/3/2018 12:46 PM
Details	State	Update	Reinstatement	Pending	Approved	10/3/2018 12:46 PM
Dates	Signed By Date	Update	Reinstatement	10/4/2012 12:00:00 AM	10/2/2018 10:14:54 AM	10/3/2018 12:46 PM
Dates	Start Date	Update	Reinstatement		1/1/2019 12:00:00 AM	10/3/2018 12:46 PM
Details	Comments Public	Insert	Reinstatement		Participating from effective date (1/1/2013) until terminated effective date (10/01/2018), reinstatement effective date (01/01/2019)	10/2/2018 10:42 AM
Contacts	Authorizing Official	Update	Reinstatement	Barnes, Joe Chief Financial Officer Stonewall Jackson Memorial Hospital 3042698050	Stalnaker, Kevin Assistant Chief Executive Officer Stonewall Jackson Memorial Hospital 3042698152	10/2/2018 9:12 AM
Details	Last Recertification Date	Update	Reinstatement	9/4/2018 5:25:21 PM		10/1/2018 3:33 PM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	9/30/2018 12:00:00 AM		10/1/2018 3:33 PM
Dates	Participating Approval Date	Update	Reinstatement	10/26/2012 12:00:00 AM		10/1/2018 3:33 PM
Details	State	Update	Reinstatement	Terminated	Pending	10/1/2018 3:33 PM
Dates	Registration Date	Update	Reinstatement	10/4/2012 12:00:00 AM	10/1/2018 3:33:25 PM	10/1/2018 3:33 PM
Dates	Start Date	Update	Reinstatement	1/1/2013 12:00:00 AM		10/1/2018 3:33 PM
Terminations	Termination Date	Update	Reinstatement	10/1/2018 12:00:00 AM		10/1/2018 3:33 PM
Terminations	Termination Effective Date	Update	Reinstatement	10/1/2018 12:00:00 AM		10/1/2018 3:33 PM
Terminations	Termination Reason	Update	Reinstatement	Failure to recertify		10/1/2018 3:33 PM
Details	State	Update		To Be Terminated	Terminated	10/1/2018 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		9/30/2018 12:00:00 AM	9/17/2018 3:51 PM
Details	State	Update	Recertification	Active	To Be Terminated	9/17/2018 3:51 PM
Terminations	Termination Date	Update	Recertification		10/1/2018 12:00:00 AM	9/17/2018 3:51 PM
Terminations	Termination Effective Date	Update	Recertification		10/1/2018 12:00:00 AM	9/17/2018 3:51 PM
Terminations	Termination Reason	Update	Recertification		Failure to recertify	9/17/2018 3:51 PM
Details	Last Recertification Date	Update	Recertification	11/14/2017 2:11:27 PM	9/4/2018 5:25:21 PM	9/4/2018 5:25 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1477559433	11/14/2017 2:11 PM
Details	Last Recertification Date	Update	Recertification	8/22/2016 12:00:00 AM	11/14/2017 2:11:27 PM	11/14/2017 2:11 PM
Contacts	Authorizing Official	Update		Barnes, Joe Chief Financial Officer 3042698050	Barnes, Joe Chief Financial Officer Stonewall Jackson Memorial Hospital 3042698050	10/4/2017 2:06 PM
Contacts	Primary Contact	Update		Pope, John Director of Pharmacy 3042698092	Pope, John Edward Director of Pharmacy Stonewall Jackson Memorial Hospital 3042698092	9/20/2017 8:48 AM
Contacts	Authorizing Official	Insert			Barnes, Joe Chief Financial Officer 3042698050	7/24/2017 1:33 PM
Contacts	Primary Contact	Update		Pope, John Director of Pharmacy 3042698092	Pope, John Director of Pharmacy 3042698092	6/16/2017 12:15 PM
Contacts	Signed By	Insert			Arbogast, Dodie Controller 3042698050	6/16/2017 12:15 PM
Addresses	Main Address	Insert			66 Hospital Plaza Weston, WV 26452	6/13/2017 1:33 PM
Contacts	Primary Contact	Insert			Pope, John Director of Pharmacy 3042698092	6/13/2017 1:28 PM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	8/22/2016 12:00:00 AM	8/22/2016 10:06 AM
Details	Last Recertification Date	Update		8/18/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/5/2015 12:43 PM
Details	Last Recertification Date	Update		8/22/2013 12:54:08 PM	8/18/2014 12:00:00 AM	8/18/2014 2:58 PM
Details	Last Recertification Date	Update			8/22/2013 12:54:08 PM	8/22/2013 12:54 PM
Details	340B ID	Update		IS-AP-DSH510038A	DSH510038A	10/26/2012 3:28 PM
Dates	Participating Approval Date	Update			10/26/2012 12:00:00 AM	10/26/2012 3:28 PM
Details	State	Update		Pending	Active	10/26/2012 3:28 PM
Dates	Start Date	Update			1/1/2013 12:00:00 AM	10/26/2012 3:28 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/19/2012 4:34 PM
Medicaid Billing	Medicaid: Number	Insert			0001417000	10/19/2012 4:34 PM
Medicaid Billing	Medicaid: State	Insert			WV	10/19/2012 4:34 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	IS-AP-DSH510038A	10/12/2012 9:15 AM
Details	Entity Subname	Update		Weston Pulmonary and Medical	Weston Pulmonary and Medical/Mahmoud Clinic Pulmonology	10/12/2012 9:15 AM
Details	Last Recertification Date	Insert				10/4/2012 11:31 AM
Details	Grant Number	Insert				10/4/2012 11:31 AM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	10/4/2012 11:31 AM
Details	Is Authorizing Official EHB Data	Insert				10/4/2012 11:31 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/4/2012 11:31 AM
Details	Medicare Provider Number	Insert			510038	10/4/2012 11:31 AM
Details	Entity Name	Insert			STONEWALL JACKSON MEMORIAL HOSPITAL	10/4/2012 11:31 AM
Details	Program Code	Insert			DSH	10/4/2012 11:31 AM
Details	Entity Subname	Insert			Weston Pulmonary and Medical	10/4/2012 11:31 AM
Dates	Participating Approval Date	Insert				10/4/2012 11:31 AM
Details	State	Insert			Pending	10/4/2012 11:31 AM
Dates	Registration Date	Insert			10/4/2012 12:00:00 AM	10/4/2012 11:31 AM
Dates	Signed By Date	Insert			10/4/2012 12:00:00 AM	10/4/2012 11:31 AM
Dates	Start Date	Insert				10/4/2012 11:31 AM
Terminations	Termination Comments	Insert				10/4/2012 11:31 AM
Terminations	Termination Date	Insert				10/4/2012 11:31 AM
Terminations	Termination Effective Date	Insert				10/4/2012 11:31 AM
Terminations	Termination Reason	Insert				10/4/2012 11:31 AM