340B Drug Pricing Program Database


CAH511315-00 POTOMAC VALLEY HOSPITAL (Active) - information as of 5/6/2025 11:10:26 PM

Main Details
POTOMAC VALLEY HOSPITAL
Critical Access Hospital
Yes
CAH511315-00
511315


Additional Details
Active
1/11/2016
4/1/2016
2/16/2016
8/12/2024

Contacts

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

WVU Medicine
Jessica Ileen Calderone, Enterprise 340B Program Manager
(304) 598-4000 Ext: 70847

Addresses

100 PIN OAK LANE
KEYSER, WV 26726

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
WV 1912979873,1770536112,1467090449,1902444987,1063649606
OH 1912979873,1770536112,1467090449,1902444987,1063649606
PA 1912979873,1770536112,1467090449,1902444987,1063649606
VA 1912979873,1770536112,1467090449,1902444987,1063649606
KY 1912979873,1770536112,1467090449,1902444987,1063649606
Shipping Addresses

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 DetailALLIED HEALTH SERVICES INC.DBA ALLIED HEALTH SOLUTIONS 3040 UNIVERSITY AVE STE 1400
MORGANTOWNWV26505-338110/12/201701/01/2018 06/01/202006/01/2020
Contract DetailALLIED HEALTH SERVICES INC.DBA ALLIED HEALTH SOLUTIONS 3040 UNIVERSITY AVE STE 1400
MORGANTOWNWV26505-338110/15/202101/01/2022 12/16/202312/16/2023
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870601/03/202504/01/2025  04/01/2025
Contract DetailMARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05728 1202 NATIONAL HWY
LA VALEMD2150201/17/202204/01/2022  04/01/2022
Contract DetailMEDISAVE PHARMACY INC.1405 BONNIE VIEW TER DBA: MED-A-SAVE PHARMACY
KEYSERWV26726-280110/14/201601/01/2017 03/31/202005/06/2020
Contract DetailREED'S DRUG STORE, LLC41 PIN OAK LN
KEYSERWV26726-591401/15/202504/01/2025  04/01/2025
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 #10-2474R.R. #4 BOX 82
KEYSERWV2672610/12/202101/01/2022  01/01/2022
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/12/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.WALGREENS #19956 839 S MINERAL ST
KEYSERWV2672601/18/202204/01/2022 02/21/202303/01/2023
Contract DetailWALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275607/13/202310/01/2023  10/01/2023
Contract DetailWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616810/10/202301/01/2024  01/01/2024
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01427 45 S. MINERAL ST.
KEYSERWV2672607/14/202010/01/2020  10/01/2020
Contract DetailWEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05961 30 HERITAGE CIRCLE
ROMNEYWV2675710/15/202401/01/2025  01/01/2025
Contract DetailWEST VIRGINIA UNIVERSITY HOSPITALS, INC.WVUH SPECIALTY PHARMACY & HOME INFUSION 3040 UNIVERSITY AVE STE 1400
MORGANTOWNWV2650512/04/202312/16/2023  12/16/2023
Contract DetailWV UNIVERSITY HOSPITALS INCDBA MEDICAL CENTER PHARMACY 1 MEDICAL CENTER DR
MORGANTOWNWV26506-120010/10/201701/01/2018 07/15/201907/24/2019
Contract DetailWV UNIVERSITY HOSPITALS INC.MOUNTAINEER PHARMACY 390 BIRCH ST
MORGANTOWNWV26505-689410/10/201701/01/2018 03/31/202005/06/2020
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
CAH511315-01ChildCAHPOTOMAC VALLEY HOSPITALPVH RHC Riverside32 2nd StPiedmontWVActive
CAH511315-02ChildCAHPOTOMAC VALLEY HOSPITALPVH RHC Elk Garden48 Oak StreetElk GardenWVTerminated
CAH511315-04ChildCAHPOTOMAC VALLEY HOSPITALPVH - MOB- General Surgery - General Surgery78 Pin Oak LaneKeyserWVTerminated
CAH511315-05ChildCAHPOTOMAC VALLEY HOSPITALPVH-MOB-WOUND CARE - WOUND CARE88 PIN OAK LANEKEYSERWVActive
CAH511315-06ChildCAHPOTOMAC VALLEY HOSPITALPVH - Cardiology of PVH - Cardiology131 Staggs LaneKeyserWVActive
CAH511315-07ChildCAHPOTOMAC VALLEY HOSPITALPVH-MOB Family Medicine - Family Medicine78 Pin Oak LaneKeyserWVTerminated
CAH511315-08ChildCAHPOTOMAC VALLEY HOSPITALPVH-MOB-ORTHO - ORTHOPEDIC HOSPITALIST SERVICES78 PIN OAK LANE, SUITE 3KEYSERWVTerminated
CAH511315-09ChildCAHPOTOMAC VALLEY HOSPITALUROLOGY CLINIC - Urology131 Staggs LaneKEYSERWVActive
CAH511315-10ChildCAHPOTOMAC VALLEY HOSPITALORTHOPEDICS OF PVH - Orthopedic Clinic25 Kight DriveKEYSERWVActive
CAH511315-11ChildCAHPOTOMAC VALLEY HOSPITALPAIN MANAGEMENT OF PVH - Pain Management131 STAGGS LNKEYSERWVActive
CAH511315-12ChildCAHPOTOMAC VALLEY HOSPITALPOTOMAC VALLEY FAMILY PRACTICE - Family Medicine514 NEW CREEK HWYKEYSERWVActive
CAH511315-13ChildCAHPOTOMAC VALLEY HOSPITALPOTOMAC VALLEY FAMILY MED- BEHAVIOR - Behavioral Health139 Plaza DriveKEYSERWVActive
CAH511315-14ChildCAHPOTOMAC VALLEY HOSPITALRural Health Clinic II - Ft Ashby - Pediatrics10261 Frankfort HighwayFort AshbyWVTerminated
CAH511315-15ChildCAHPOTOMAC VALLEY HOSPITALRural Health Clinic III - Pulmonology78 Pin Oak LaneKeyserWVActive
CAH511315-16ChildCAHPOTOMAC VALLEY HOSPITALRural Health Clinic III - Family Medicine78 Pin Oak LaneKeyserWVActive
CAH511315-17ChildCAHPOTOMAC VALLEY HOSPITALRural Health Clinic III - General Surgery78 Pin Oak LaneKeyserWVActive
CAH511315-18ChildCAHPOTOMAC VALLEY HOSPITALRural Health Clinic II - Ft Ashby - Family Medicine10261 Frankfort HighwayFort AshbyWVActive
CAH511315-19ChildCAHPOTOMAC VALLEY HOSPITALRural Health Clinic III - PVH Emergency Medicine Urgent Care131 Plaza DriveKeyserWVActive
CAH511315-20ChildCAHPOTOMAC VALLEY HOSPITALRural Health Clinic II - Pulmonology10261 Frankfort HighwayFort AshbyWVActive
CAH511315-21ChildCAHPOTOMAC VALLEY HOSPITALPVH Podiatry - Podiatry131 Staggs LaneKeyserWVActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
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 26505-001510/8/2024 8:03 AM
DetailsLast Recertification DateUpdateRecertification8/14/2023 7:23:46 AM8/12/2024 3:42:20 PM8/12/2024 3:42 PM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request3810000637 (WV) 6/4/2024 8:07 PM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request005025300 (MD) 5/31/2024 6:07 PM
Medicaid BillingNPI: NumberDeleteGroup Change Request1912979873 (MD) 5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 17705361125/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request WV5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 14670904495/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request WV5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19024449875/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request WV5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 10636496065/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request WV5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19129798735/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request OH5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 17705361125/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request OH5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 14670904495/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request OH5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19024449875/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request OH5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 10636496065/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request OH5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19129798735/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request PA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 17705361125/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request PA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 14670904495/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request PA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19024449875/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request PA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 10636496065/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request PA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19129798735/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request VA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 17705361125/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request VA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 14670904495/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request VA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19024449875/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request VA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 10636496065/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request VA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19129798735/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request KY5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 17705361125/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request KY5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 14670904495/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request KY5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19024449875/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request KY5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 10636496065/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request KY5/31/2024 6:07 PM
ContactsPrimary ContactUpdateProfile Change RequestCalderone, Jessica Ileen Enterprise 340B Program Manager WVU Medicine 7248755615Calderone, Jessica Ileen Enterprise 340B Program Manager WVU Medicine 3045984000-708479/27/2023 1:59 PM
DetailsLast Recertification DateUpdateRecertification8/31/2022 12:17:45 PM8/14/2023 7:23:46 AM8/14/2023 7:23 AM
DetailsLast Recertification DateUpdateRecertification8/27/2021 11:43:33 AM8/31/2022 12:17:45 PM8/31/2022 12:17 PM
ContactsPrimary ContactUpdateGroup Change RequestCalderone, Jessica Enterprise 340B Program Manager WVU Medicine 7248755615Calderone, Jessica Ileen Enterprise 340B Program Manager WVU Medicine 72487556151/24/2022 9:08 AM
ContactsPrimary ContactUpdateGroup Change RequestFamoso, Karen Lynn Enterprise Director, Compliance and Business Operations WVU Medicine 3042812986Calderone, Jessica Enterprise 340B Program Manager WVU Medicine 72487556151/24/2022 7:38 AM
DetailsLast Recertification DateUpdateRecertification8/18/2020 6:52:23 AM8/27/2021 11:43:33 AM8/27/2021 11:43 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/7/2021 5:28 AM
Medicaid BillingMedicaid: NumberInsertChange Request 38100006376/7/2021 5:28 AM
Medicaid BillingMedicaid: StateInsertChange Request WV6/7/2021 5:28 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/7/2021 5:28 AM
Medicaid BillingMedicaid: NumberInsertChange Request 0050253006/7/2021 5:28 AM
Medicaid BillingMedicaid: StateInsertChange Request MD6/7/2021 5:28 AM
Medicaid BillingNPI: NumberInsertChange Request 19129798736/7/2021 5:28 AM
Medicaid BillingNPI: StateInsertChange Request WV6/7/2021 5:28 AM
Medicaid BillingNPI: NumberInsertChange Request 19129798736/7/2021 5:28 AM
Medicaid BillingNPI: StateInsertChange Request MD6/7/2021 5:28 AM
ContactsAuthorizing OfficialUpdateChange RequestGibson, Justin J VP of Finance Potomac Valley Hospital 3045984256Gibson, Justin VP of Finance-North Region West Virginia University Healthcare 304598408510/19/2020 3:14 PM
DetailsLast Recertification DateUpdateRecertification8/21/2019 8:16:52 PM8/18/2020 6:52:23 AM8/18/2020 6:52 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
AddressesMain AddressUpdateChange Request PIN OAK LANE KEYSER, WV 26726 100 PIN OAK LANE KEYSER, WV 267262/27/2020 7:45 AM
DetailsLast Recertification DateUpdateRecertification8/28/2018 2:37:19 PM8/21/2019 8:16:52 PM8/21/2019 8:16 PM
ContactsPrimary ContactUpdateChange RequestTroup, Jonathan Director of Pharmacy Potomac Valley Hospital 3045973659Famoso, Karen Lynn Regional Director of Pharmacy Camden Clark Medical Center 30422145348/7/2019 7:02 AM
DetailsLast Recertification DateUpdateRecertification11/29/2017 12:31:42 PM8/28/2018 2:37:19 PM8/28/2018 2:37 PM
ContactsAuthorizing OfficialUpdateChange RequestShroyer, Linda CEO Potomac Valley Hospital 3045973510Gibson, Justin J VP of Finance Potomac Valley Hospital 30459842567/23/2018 7:41 AM
DetailsLast Recertification DateUpdateRecertification8/15/2016 12:00:00 AM11/29/2017 12:31:42 PM11/29/2017 12:31 PM
ContactsAuthorizing OfficialUpdate Shroyer, Linda CEO 3045973510Shroyer, Linda CEO Potomac Valley Hospital 304597351010/10/2017 12:24 PM
ContactsSigned ByUpdate Shroyer, Linda CEO 3045973510Shroyer, Linda CEO Potomac Valley Hospital 304597351010/10/2017 12:24 PM
ContactsPrimary ContactUpdate Troup, Jonathan Director of Pharmacy 3045973659Troup, Jonathan Director of Pharmacy Potomac Valley Hospital 304597365910/3/2017 2:34 PM
AddressesMain AddressInsert   PIN OAK LANE KEYSER, WV 2672610/17/2016 2:15 PM
ContactsAuthorizing OfficialInsert  Shroyer, Linda CEO 304597351010/17/2016 2:15 PM
ContactsSigned ByInsert  Shroyer, Linda CEO 304597351010/17/2016 2:15 PM
ContactsPrimary ContactInsert  Troup, Jonathan Director of Pharmacy 304597365910/17/2016 2:15 PM
DetailsLast Recertification DateUpdate  8/15/2016 12:00:00 AM8/15/2016 12:32 PM
DatesParticipating Approval DateUpdate  2/16/2016 12:00:00 AM2/16/2016 12:49 PM
DetailsStateUpdate PendingActive2/16/2016 12:49 PM
DatesStart DateUpdate  4/1/2016 12:00:00 AM2/16/2016 12:49 PM
Details340B IDUpdate ONLINE_REG_57016CAH511315-002/2/2016 11:23 AM
Details340B IDUpdate  ONLINE_REG_570161/11/2016 12:21 PM
DetailsLast Recertification DateInsert   1/11/2016 12:21 PM
DetailsGrant NumberInsert   1/11/2016 12:21 PM
Details340B IDInsert   1/11/2016 12:21 PM
DetailsIs Authorizing Official EHB DataInsert   1/11/2016 12:21 PM
DatesLast Date That 340B Drugs PurchasedInsert   1/11/2016 12:21 PM
DetailsMedicare Provider NumberInsert  5113151/11/2016 12:21 PM
DetailsEntity NameInsert  POTOMAC VALLEY HOSPITAL1/11/2016 12:21 PM
DetailsProgram CodeInsert  CAH1/11/2016 12:21 PM
DetailsEntity SubnameInsert   1/11/2016 12:21 PM
DatesParticipating Approval DateInsert   1/11/2016 12:21 PM
DetailsStateInsert  Pending1/11/2016 12:21 PM
DatesRegistration DateInsert  1/11/2016 12:00:00 AM1/11/2016 12:21 PM
DatesSigned By DateInsert  1/11/2016 12:00:00 AM1/11/2016 12:21 PM
DatesStart DateInsert   1/11/2016 12:21 PM
TerminationsTermination CommentsInsert   1/11/2016 12:21 PM
TerminationsTermination DateInsert   1/11/2016 12:21 PM
TerminationsTermination Effective DateInsert   1/11/2016 12:21 PM
TerminationsTermination ReasonInsert   1/11/2016 12:21 PM