Covered Entity Details

DSH510055L Cabell Huntington Hospital, Inc. (Active) - information as of 5/17/2025 10:54:18 PM

Main Details

Name

Cabell Huntington Hospital, Inc.

Subdivision Name

CHH Center for Wound Healing

Type

Disproportionate Share Hospital

Rural

340B ID

DSH510055L

Medicare Provider Number

510055

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/8/2013

Participating Start Date

10/1/2013

Participating Approval Date

9/13/2013

Last Recertification Date

9/5/2024

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

1600 Medical Center Drive
Suite 2500
Huntington, WV 25701

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
OH	1217758	1073518007
KY	01690049	1073518007
WV	1073518007	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
Medicaid Billing	Medicaid: Number	Delete	Change Request	0001144000 (WV)		10/1/2024 3:02 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	7100297230 (KY)		10/1/2024 3:02 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0102601 (OH)		10/1/2024 3:02 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	3910005486 (WV)		10/1/2024 3:02 PM
Details	Last Recertification Date	Update	Recertification	8/18/2023 7:44:27 AM	9/5/2024 10:49:52 AM	9/5/2024 10:49 AM
Details	Last Recertification Date	Update	Recertification	8/25/2022 7:59:03 AM	8/18/2023 7:44:27 AM	8/18/2023 7:44 AM
Details	Last Recertification Date	Update	Recertification	8/16/2021 8:26:03 AM	8/25/2022 7:59:03 AM	8/25/2022 7:59 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (GA)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (NV)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (SC)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (IA)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (ME)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (IN)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (MI)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (MN)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (NC)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (LA)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (OK)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (MD)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (WA)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (CO)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (DC)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (NJ)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (TX)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (PA)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (FL)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (AZ)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (MS)		4/14/2022 7:47 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1073518007 (TN)		4/14/2022 7:47 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	930314 (AZ)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	3722287 (CO)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	60178304 (DC)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	913361500 (FL)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	003190401A (GA)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1073518007 (IA)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	300012531 (IN)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1073518007 (IN)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1748528 (LA)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	206059007 (MD)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1073518007 (ME)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1073518007 (MI)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1073518007 (MN)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	96540 (MS)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1073518007 (NC)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	60195888 (NJ)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	100544943 (NV)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	200294080A (OK)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	8889340001 (PA)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	10375A (SC)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	10783B (SC)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1073518007 (SC)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	Q037890 (TN)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	72966704 (TX)		3/4/2022 7:44 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	2126926 (WA)		3/4/2022 7:44 AM
Contacts	Authorizing Official	Update	AO Change Request	Ward, David M Sr. Vp/Cfo Cabell Huntington Hospital 3045262055	Blevins, Aaron C Chief Pharmacy Officer St. Mary's Medical Center 3045268250	1/24/2022 11:24 AM
Details	Last Recertification Date	Update	Recertification	8/25/2020 10:05:53 AM	8/16/2021 8:26:03 AM	8/16/2021 8:26 AM
Details	Entity Subname	Update	Change Request	Wound Care	CHH Center for Wound Healing	4/6/2021 11:11 AM
Medicaid Billing	Medicaid: Number	Update		7100297230	7100297230	12/10/2020 4:18 PM
Addresses	Main Address	Update	Recertification	1600 Medical Center Drive 2500 Huntington, WV 25701	1600 Medical Center Drive Suite 2500 Huntington, WV 25701	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1073518007 ( )		8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		KY	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		WV	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		OH	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		NV	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		SC	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		IA	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		ME	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		IN	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		MI	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		MN	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		NC	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		LA	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		OK	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		WA	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		CO	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		DC	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		TX	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		MS	8/25/2020 10:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073518007	8/25/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		TN	8/25/2020 10:05 AM
Details	Last Recertification Date	Update	Recertification	8/27/2019 7:59:23 AM	8/25/2020 10:05:53 AM	8/25/2020 10:05 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		930314	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		AZ	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		3722287	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CO	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		60178304	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		DC	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		913361500	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003190401A	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1073518007	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IA	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		300012531	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1073518007	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1748528	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		206059007	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1073518007	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		ME	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1073518007	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MI	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1073518007	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MN	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		96540	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MS	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1073518007	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		60195888	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NJ	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100544943	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NV	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		200294080A	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OK	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		8889340001	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		10375A	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		10783B	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1073518007	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		Q037890	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		72966704	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		2126926	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1073518007	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		WV	4/30/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/20/2019 12:52 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0001144000	9/20/2019 12:52 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WV	9/20/2019 12:52 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/20/2019 12:52 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1217758	9/20/2019 12:52 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	9/20/2019 12:52 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/20/2019 12:52 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		01690049	9/20/2019 12:52 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	9/20/2019 12:52 PM
Details	Last Recertification Date	Update	Recertification	9/4/2018 8:14:12 AM	8/27/2019 7:59:23 AM	8/27/2019 7:59 AM
Details	Entity Name	Update	Change Request	CABELL HUNTINGTON HOSPITAL, INC.	Cabell Huntington Hospital, Inc.	7/26/2019 6:26 AM
Addresses	Main Address	Update	Change Request	1115 20th Street Ste 103 Huntington, WV 25703	1600 Medical Center Drive 2500 Huntington, WV 25701	7/25/2019 3:02 PM
Addresses	Billing Address	Insert	Change Request		Cabell Huntington Hospital, Inc. 1340 Hal Greer Blvd. Huntington, WV 25701-0195	5/6/2019 9:49 AM
Addresses	Shipping Address	Insert	Change Request		Cabell Huntington Hospital, Inc. 1340 Hal Greer Blvd. Huntington, WV 25701-0195	5/6/2019 9:49 AM
Contacts	Primary Contact	Update	Change Request	Morgan, Sherri Dawn Director of Pharmacy Cabell Huntington Hospital 3045262102	Crutchley, Rebecca Briana 340B Coordinator Cabell Huntington Hospital 3043994690	4/23/2019 1:21 PM
Details	Last Recertification Date	Update	Recertification	11/14/2017 8:27:34 AM	9/4/2018 8:14:12 AM	9/4/2018 8:14 AM
Contacts	Primary Contact	Update	Recertification	Fenerty, Jeffrey Assistant Pharmacy Director 3045262133	Morgan, Sherri Dawn Director of Pharmacy Cabell Huntington Hospital 3045262102	11/14/2017 8:27 AM
Details	Last Recertification Date	Update	Recertification	8/15/2016 12:00:00 AM	11/14/2017 8:27:34 AM	11/14/2017 8:27 AM
Contacts	Authorizing Official	Insert	AO Change Request		Ward, David M Sr. Vp/Cfo Cabell Huntington Hospital 3045262055	10/12/2017 2:31 PM
Contacts	Signed By	Insert			Ward, David M. SENIOR VP AND CfO 3045262274	7/17/2017 1:28 PM
Addresses	Main Address	Insert			1115 20th Street Ste 103 Huntington, WV 25703	2/15/2017 4:31 PM
Details	Last Recertification Date	Update		8/13/2015 12:00:00 AM	8/15/2016 12:00:00 AM	8/15/2016 11:00 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/13/2015 6:35 PM
Medicaid Billing	Medicaid: Number	Insert			7100297230	8/13/2015 6:35 PM
Medicaid Billing	Medicaid: State	Insert			KY	8/13/2015 6:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/13/2015 6:35 PM
Medicaid Billing	Medicaid: Number	Insert			0102601	8/13/2015 6:35 PM
Medicaid Billing	Medicaid: State	Insert			OH	8/13/2015 6:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/13/2015 6:35 PM
Medicaid Billing	Medicaid: Number	Insert			3910005486	8/13/2015 6:35 PM
Medicaid Billing	Medicaid: State	Insert			WV	8/13/2015 6:35 PM
Details	Last Recertification Date	Update		8/18/2014 12:00:00 AM	8/13/2015 12:00:00 AM	8/13/2015 6:35 PM
Details	Last Recertification Date	Update			8/18/2014 12:00:00 AM	8/18/2014 2:59 PM
Contacts	Primary Contact	Insert			Fenerty, Jeffrey Assistant Pharmacy Director 3045262133	9/17/2013 3:28 PM
Dates	Participating Approval Date	Update			9/13/2013 12:00:00 AM	9/13/2013 12:08 PM
Details	State	Update		Pending	Active	9/13/2013 12:08 PM
Dates	Start Date	Update			10/1/2013 12:00:00 AM	9/13/2013 12:08 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH510055L	7/17/2013 4:06 PM
Medicaid Billing	NPI: Number	Insert			1073518007	7/8/2013 2:05 PM
Details	Last Recertification Date	Insert				7/8/2013 2:05 PM
Details	Grant Number	Insert				7/8/2013 2:05 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	7/8/2013 2:05 PM
Details	Is Authorizing Official EHB Data	Insert				7/8/2013 2:05 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/8/2013 2:05 PM
Details	Medicare Provider Number	Insert			510055	7/8/2013 2:05 PM
Details	Entity Name	Insert			CABELL HUNTINGTON HOSPITAL, INC.	7/8/2013 2:05 PM
Details	Program Code	Insert			DSH	7/8/2013 2:05 PM
Details	Entity Subname	Insert			Wound Care	7/8/2013 2:05 PM
Dates	Participating Approval Date	Insert				7/8/2013 2:05 PM
Details	State	Insert			Pending	7/8/2013 2:05 PM
Dates	Registration Date	Insert			7/8/2013 12:00:00 AM	7/8/2013 2:05 PM
Dates	Signed By Date	Insert			7/8/2013 12:00:00 AM	7/8/2013 2:05 PM
Dates	Start Date	Insert				7/8/2013 2:05 PM
Terminations	Termination Comments	Insert				7/8/2013 2:05 PM
Terminations	Termination Date	Insert				7/8/2013 2:05 PM
Terminations	Termination Effective Date	Insert				7/8/2013 2:05 PM
Terminations	Termination Reason	Insert				7/8/2013 2:05 PM