Covered Entity Details

DSH510022CH CHARLESTON AREA MEDICAL CENTER (CAMC) (Active) - information as of 4/24/2025 11:59:34 PM

Main Details

Name

CHARLESTON AREA MEDICAL CENTER (CAMC)

Subdivision Name

CAMC Infectious Disease

Type

Disproportionate Share Hospital

Rural

340B ID

DSH510022CH

Medicare Provider Number

510022

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/15/2016

Participating Start Date

7/1/2016

Participating Approval Date

4/21/2016

Last Recertification Date

8/22/2024

Contacts

Authorizing Official

CAMC Health System
Jeff D Sandene, EVP CFO
(304) 388-7603

Primary Contact

Vandalia Health
Brian Sayre, VP of Pharmacy Services
(304) 388-8917

Addresses

Street Address

3200 MacCorkle Avenue, S.E.
Charleston, WV 25304

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?
Yes

State	Medicaid Number	NPI Number
WV		1952390239

Shipping Addresses

Shipping Address 1

CAMC Infectious Disease
3200 MacCorkle Avenue, S.E.
Charleston, WV 25304

Shipping Address 2

CAMC Pharmacy #3
3415 MacCorkle Ave SE
Charleston, WV 25304

Shipping Address 3

CAMC Pharmacy
3200 MacCorkle Ave SE
Charleston, WV 25304

Shipping Address 4

CAMC Memorial Hospital Pharmacy
3200 MacCorkle Ave SE
Charleston, WV 25304

Shipping Address 5

CAMC Pharmacy #2
501 Morris St.
Charleston, WV 25301

Shipping Address 6

CAMC Pharmacy #4
3948 Teays Valley Road
Hurricane, WV 25526

Shipping Address 7

CAMC Pharmacy #5
400 Association Drive
Charleston, WV 25311-1295

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
DSH510022AA	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Nuclear Medicine	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022AB	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial MRI	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022AC	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Endoscopy	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022AD	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Family Medicine Center	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022AE	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial O/P Care Center	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022AF	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Recovery Room	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022AG	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Surgicenter	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022AH	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Women & Childrens Emergency Room	800 Pennsylvania Avenue	Charleston	WV	Active
DSH510022AJ	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Women & Childrens Delivery Room & Labor Room	800 Pennsylvania Avenue	Charleston	WV	Active
DSH510022AK	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Women & Childrens Operating Room	800 Pennsylvania Avenue	Charleston	WV	Active
DSH510022AL	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Women & Childrens Anesthesia	800 Pennsylvania Avenue	Charleston	WV	Active
DSH510022AM	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Women & Childrens Recovery Room	800 Pennsylvania Avenue	Charleston	WV	Active
DSH510022AN	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Women & Childrens Respiratory Care	800 Pennsylvania Avenue	Charleston	WV	Active
DSH510022AP	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Women & Childrens Radiology	800 Pennsylvania Avenue	Charleston	WV	Active
DSH510022AQ	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Women & Childrens CT Scan	800 Pennsylvania Avenue	Charleston	WV	Active
DSH510022AR	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Women & Childrens Nuclear Medicine	800 Pennsylvania Avenue	Charleston	WV	Active
DSH510022AS	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Women & Childrens MRI	800 Pennsylvania Avenue	Charleston	WV	Active
DSH510022AU	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Obstetrics and Gynecology Center (formerly WMC)	800 Pennsylvania Avenue	Charleston	WV	Active
DSH510022AV	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	OP Imaging Center	3416 MacCorkle Ave. SE	Charleston	WV	Active
DSH510022AW	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Imaging Center-Southridge (Mountaineer Imaging)	60 R.H.L Blvd	South Charleston	WV	Active
DSH510022AX	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Post Cardiac Cath Unit	3200 MacCorkle Avenue SE	Charleston	WV	Terminated
DSH510022AY	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Women & Childrens Pediatrics Specialty Unit	800 Pennsylvania Avenue	Charleston	WV	Active
DSH510022AZ	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley Operating Room	1400 Hospital Drive	Hurricane	WV	Active
DSH510022B	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC MEMORIAL OBSERVATION BEDS	3200 MACCORKLE AVENUE SE	CHARLESTON	WV	Active
DSH510022BA	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley Endoscopy	1400 Hospital Drive	Hurricane	WV	Active
DSH510022BB	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley Post Anesthesia Care Unit	1400 Hospital Drive	Hurricane	WV	Active
DSH510022BC	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley Radiology	1400 Hospital Drive	Hurricane	WV	Active
DSH510022BD	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley Radiology Ultrasound	1400 Hospital Drive	Hurricane	WV	Active
DSH510022BE	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley MRI	1400 Hospital Drive	Hurricane	WV	Active
DSH510022BF	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley Mammography	1400 Hospital Drive	Hurricane	WV	Active
DSH510022BG	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley Nuclear Medicine	1400 Hospital Drive	Hurricane	WV	Active
DSH510022BH	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley CT Scan	1400 Hospital Drive	Hurricane	WV	Active
DSH510022BJ	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley Respiratory Care	1400 Hospital Drive	Hurricane	WV	Active
DSH510022BK	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley Physical Therapy	3948 Teays Valley Road	Hurricane	WV	Active
DSH510022BL	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley Hyperbaric Chamber	1400 Hospital Drive	Hurricane	WV	Active
DSH510022BM	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley Cardiac Rehab	1400 Hospital Drive	Hurricane	WV	Active
DSH510022BN	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley Short Stay Surgery	1400 Hospital Drive	Hurricane	WV	Active
DSH510022BP	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley Ambulatory Infusion	1400 Hospital Drive	Hurricane	WV	Active
DSH510022BQ	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley Emergency Room	1400 Hospital Drive	Hurricane	WV	Active
DSH510022BR	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley Doctor's Park Clinic	1206 Hospital Drive	Hurricane	WV	Active
DSH510022BS	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley TVH Vascular Center	3948 Teays Valley Road	Hurricane	WV	Active
DSH510022BT	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley Anesthesia	1400 Hospital Drive	Hurricane	WV	Active
DSH510022BU	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	WEIGHT LOSS CENTER	Northgate Business Park	CHARLESTON	WV	Active
DSH510022BV	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Urology - Teays Valley	3948 Teays Valley Road	Hurricane	WV	Active
DSH510022BW	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Urology	1220 Lee Street, East	Charleston	WV	Active
DSH510022BX	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Urology - Memorial	3100 MacCorkle Avenue, S.E.	Charleston	WV	Active
DSH510022BY	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Pediatric Surgery	830 Pennsylvania Avenue	Charleston	WV	Active
DSH510022BZ	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Pediatric Neurology	830 Pennsylvania Avenue	Charleston	WV	Active
DSH510022C	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC WOMEN & CHILDRENS OBSERVATION BEDS	800 PENNSYLVANIA AVENUE	CHARLESTON	WV	Active
DSH510022CA	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Pediatric ENT	830 Pennsylvania Avenue	Charleston	WV	Active
DSH510022CB	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Orthopedic Trauma	415 Morris St.	Charleston	WV	Active
DSH510022CC	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Orthopedic Surgery	3100 MacCorkle Ave, S.E.	Charleston	WV	Terminated
DSH510022CD	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Ophthalmology	1220 Lee St. East	Charleston	WV	Active
DSH510022CE	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Neurology - Teays Valley	3948 Teays Valley Road	Hurricane	WV	Active
DSH510022CF	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Neurology	415 Morris Street	Charleston	WV	Active
DSH510022CG	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Associated Cardiology - CAMC Cardiology	3100 MacCorkle Ave SE	Charleston	WV	Active
DSH510022CH	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Infectious Disease	3200 MacCorkle Avenue, S.E.	Charleston	WV	Active
DSH510022CJ	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC General Surgery	3100 MacCorkle Ave, S.E.	Charleston	WV	Active
DSH510022CK	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC FACIAL SURGERY I	415 Morris Street	Charleston	WV	Active
DSH510022CL	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC FACIAL SURGERY II - CAMC Cleft & Craniofacial Center	830 Pennsylvania Avenue	Charleston	WV	Active
DSH510022CM	Child	DSH	CHARLESTON AREA MEDICAL CENTER INC.	CAMC Dental Center	3100 MacCorkle Ave SE	Charleston	WV	Terminated
DSH510022CN	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Cardiovascular Surgery	3100 MacCorkle Avenue, SE	Charleston	WV	Active
DSH510022CP	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Cancer Center Oncology	CAMC Cancer Center Oncology	Charleston	WV	Active
DSH510022CQ	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC BARIATRIC SURGERY	600 Tracy Way	Charleston	WV	Terminated
DSH510022CR	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC CHARLESTON HEART SPECIALISTS	2335 CHESTERFIELD AVE	CHARLESTON	WV	Terminated
DSH510022CS	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC ASSOCIATED CARDIOLOGY	2930 CHESTERFIELD AVE	CHARLESTON	WV	Terminated
DSH510022CT	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Gastroenterology (GI) Clinic	3200 MacCorkle Avenue, S.E.	Charleston	WV	Terminated
DSH510022CU	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial / Clinical Decision Unit	3200 MacCorkle Ave SE	Charleston	WV	Active
DSH510022CV	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Gynecology Oncology	13 Courtney Drive	Charleston	WV	Active
DSH510022CW	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC O/P Care Center / Ambulatory Care Clinic	3200 MacCorkle Ave SE	Charleston	WV	Terminated
DSH510022CX	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Cardiac Rehab / Cardiac Rehab	3200 MacCorkle Ave SE	Charleston	WV	Active
DSH510022CY	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC / OB/GYN Clinic	830 Pennsylvania Ave	Charleston	WV	Active
DSH510022CZ	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Physical Therapy Center/Sports Medicine	600 Tracy Way	Charleston	WV	Active
DSH510022DA	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Urologic Surgery	100 Tracy Way	Charleston	WV	Active
DSH510022DB	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Primary Care - Winfield	12576 Winfield Rd.	Winfield	WV	Active
DSH510022DC	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Primary Care - Nitro	4111 First Avenue, Suite 3	Nitro	WV	Active
DSH510022DD	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Orthopedics Teays Valley	3948 Teays Valley Road	Hurricane	WV	Active
DSH510022DE	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Plastic Surgery	210 Brooks Street	Charleston	WV	Active
DSH510022DF	Child	DSH	CHARLESTON AREA MEDICAL CENTER INC.	CAMC Fertility Center (IVF - Lab)	830 Pennsylvania Avenue	Charleston	WV	Terminated
DSH510022DG	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Pediatric Clinic / Pediatric Service	800 Pennsylvania Avenue	Charleston	WV	Terminated
DSH510022DH	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Teays Valley Hospital / Observation Beds-Med/Surg	1400 Hospital Drive	Hurricane	WV	Active
DSH510022DJ	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Cardiology - South Charleston - Cardiology - South Charleston	4610 Kanawha Ave, SW	South Charleston	WV	Active
DSH510022DK	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Primary Care - TV - CAMC Primary Care - TV	3248 Teays Valley Road	Hurricane	WV	Active
DSH510022DL	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	OP Surg Center - Gen - OP Surg Center - Gen	1220 Lee St. East	Charleston	WV	Active
DSH510022DM	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Surgery - TV - General Surgery	3948 Teays Valley Road	Hurricane	WV	Active
DSH510022DN	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Electrophysiology - CAMC Electrophysiology	3100 MacCorkle Avenue, SE	Charleston	WV	Active
DSH510022DP	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Stroke Center - Occupational Health and Wellness WCH	800 Pennsylvania Avenue	Charleston	WV	Terminated
DSH510022DQ	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Occupational Health and Wellness MEM - Occupational Health and Wellness MEM	3100 MacCorkle Avenue, SE	Charleston	WV	Terminated
DSH510022DR	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Occupational Health and Wellness TVH - Occupational Health and Wellness TVH	1400 Hospital Drive	Hurricane	WV	Terminated
DSH510022DS	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Rheumatology - CAMC Rheumatology	4610 Kanawha Ave SW	South Charleston	WV	Terminated
DSH510022DT	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC PERINATAL DIAG CTR CLINIC WCH - Women & Childrens Perinatal Diagnostic Center	800 PENNSYLVANIA AVE	CHARLESTON	WV	Active
DSH510022DU	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Non-Invasive Vascular Clinic - Teays Valley Non-Invasive Vascular Lab	1400 Hospital Drive	Hurricane	WV	Active
DSH510022DV	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC EMPLOYEE WELLNESS CENTER - Employee Wellness Center	3418 STAUNTON AVE SE	CHARLESTON	WV	Active
DSH510022DW	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Electrocardiology - CAMC Memorial EKG	3200 MacCorkle Ave SE	Charleston	WV	Active
DSH510022DX	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Electrocardiology - CAMC Women & Childrens EKG	800 Pennsylvania Avenue	Charleston	WV	Active
DSH510022DY	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Nuclear Med/Cobalt - Memorial Radiation Therapy	3200 MacCorkle Ave SE	Charleston	WV	Active
DSH510022DZ	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Electroencephalography - CAMC Women & Childrens Neurodiagnostics EEG	800 Pennsylvania Ave	Charleston	WV	Active
DSH510022E	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC INFUSION SERVICES	3415 MacCorkle Ave SE	CHARLESTON	WV	Active
DSH510022EA	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Pulmonary Function Testing - CAMC Memorial Perfusion	3200 MacCorkle Ave SE	Charleston	WV	Active
DSH510022EB	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Laboratory - CAMC Memorial Laboratory	3200 MacCorkle Ave SE	Charleston	WV	Active
DSH510022EC	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Radiology - Diagnostic - CAMC Memorial Radiology Ultrasound	3200 MacCorkle Ave SE	Charleston	WV	Active
DSH510022ED	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Blood Storing, Processing, & Trans. - CAMC Memorial Transfusion Services	3200 MacCorkle Ave SE	Charleston	WV	Active
DSH510022EE	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Radiology - Diagnostic - Women & Childrens OB Ultrasound	800 Pennsylvania Ave	Charleston	WV	Active
DSH510022EF	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Electroencephalography - CAMC Memorial Neurodiagnostics EEG	3200 MacCorkle Ave SE	Charleston	WV	Active
DSH510022EG	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Laboratory - Teays Valley Laboratory	1400 Hospital Drive	Hurricane	WV	Active
DSH510022EH	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Electroencephalography - Teays Valley Echocardiogram	1400 Hospital Drive	Hurricane	WV	Active
DSH510022EJ	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Radiology - Diagnostic - Teays Valley CDL Lab	1400 Hospital Drive	Hurricane	WV	Active
DSH510022EK	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Laboratory - CAMC Memorial Lab Microbiology	3200 MacCorkle Ave SE	Charleston	WV	Active
DSH510022EL	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC INFECTIOUS DISEASE - CAMC Infectious Disease MSOB	3100 MACCORKLE AVE SE	CHARLESTON	WV	Active
DSH510022EM	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC PED DEPARTMENTS - Pediatric Pulmonology	830 Pennsylvania Avenue	Charleston	WV	Active
DSH510022EN	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	G.I. - CAMC Gastroenterology	2930 Chesterfield Avenue	Charleston	WV	Active
DSH510022EP	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Physical Therapy - WCH	800 Pennsylvania Avenue	Charleston	WV	Active
DSH510022EQ	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC PED DEPARTMENTS - Pediatric Rheumatology	830 Pennsylvania Avenue	Charleston	WV	Active
DSH510022ER	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Internal Med - Internal Medicine Office	3100 MacCorkle Ave. SE	Charleston	WV	Active
DSH510022ES	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC PED DEPARTMENTS - Pediatric Endocrinology	830 Pennsylvania Avenue	Charleston	WV	Active
DSH510022ET	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	TELEMEDICINE - 24/7 Cares	415 Morris Street	Charleston	WV	Active
DSH510022EU	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC PED DEPARTMENTS - Pediatric Cardiology	830 Pennsylvania Avenue	Charleston	WV	Active
DSH510022EV	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC PED DEPARTMENTS - Pediatric Develop & Behavior	830 Pennsylvania Avenue	Charleston	WV	Active
DSH510022EW	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC CARDIOLOGY - TEAYS VALLEY - Cardiology Teays Valley	3948 Teays Valley Road	HURRICANE	WV	Active
DSH510022EX	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Endocrinology - Endocrinology Clinic	3100 MacCorkle Ave. SE	Charleston	WV	Active
DSH510022EY	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC PED DEPARTMENTS - Pediatric Gastroenterology	830 Pennsylvania Avenue	Charleston	WV	Active
DSH510022EZ	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC PRIMARY CARE CHARLESTON - Primary Care Charleston	3411 Noyes Ave	CHARLESTON	WV	Active
DSH510022F	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC HEMOPHILIA TREATMENT CENTER	3200 MACCORKLE AVE SE	CHARLESTON	WV	Active
DSH510022FA	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC KIDNEY ACQUISITION - CAMC Kidney Transplant Clinic	415 Morris Street	Charleston	WV	Active
DSH510022FB	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC PED DEPARTMENTS - Pediatric Infectious Disease	830 Pennsylvania Avenue	Charleston	WV	Active
DSH510022FC	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Rheumatology Clinic - CAMC Rheumatology	3100 MacCorkle Ave. SE	Charleston	WV	Active
DSH510022FD	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Physical Therapy - Memorial	3200 MacCorkle Ave. SE	Charleston	WV	Active
DSH510022FE	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	OPERATING ROOM - Patient AM Admission - Memorial PAC	3200 MacCorkle Ave. SE	Charleston	WV	Active
DSH510022FF	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC PED DEPARTMENTS - Hematology & Onc	830 Pennsylvania Avenue	Charleston	WV	Active
DSH510022FG	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC PED DEPARTMENTS - CF Center	830 Pennsylvania Avenue	Charleston	WV	Active
DSH510022FH	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Recovery Room - Patient Access Center- WCH	800 Pennsylvania Avenue	Charleston	WV	Active
DSH510022FJ	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC PULMONOLOGY - Pulmonology MSOB	3100 MACCORKLE AVE SE	CHARLESTON	WV	Active
DSH510022FK	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Behavioral Medicine Center - Behavioral Medicine Center	3200 MacCorkle Avenue	Charleston	WV	Active
DSH510022FL	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Trauma Surgery - Trauma Surgery	1220 Lee Street	Charleston	WV	Active
DSH510022FM	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Pediatric Nephrology - CAMC Pediatric Nephrology	830 Pennsylvania Avenue	Charleston	WV	Active
DSH510022FN	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Ryan White Program - CAMC ID	3200 MacCorkle Avenue	Charleston	WV	Active
DSH510022FP	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	OB/GYN TV - OB GYN Teays	1401 Hospital Drive	Hurricane	WV	Active
DSH510022FQ	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Rheumatology - CAMC Rheumatology TV	1401 Hospital Drive	Hurricane	WV	Active
DSH510022FR	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Pulmonary TV - CAMC Pulmonary Teays Valley	1401 Hospital Drive	Hurricane	WV	Active
DSH510022FS	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Mobile Clinic - Mobile Clinic	3200 MacCorkle Avenue	Charleston	WV	Active
DSH510022FT	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC GI TV - G.I. Teays Valley	3948 Teays Valley Road	Hurricane	WV	Active
DSH510022FU	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Cardiac Rehab SC - CAMC Cardiopulm Rehab SC	4610 Kanawha Avenue SW	South Charleston	WV	Active
DSH510022FV	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Rheumatology - Rheumatology South Charleston	4610 Kanawha Avenue SW	South Charleston	WV	Active
DSH510022FW	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	General Surgery Clinic - CAMC General Surgery	3100 MacCorkle Avenue	Charleston	WV	Active
DSH510022FX	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC NEPHROLOGY - Nephrology	2345 CHESTERFIELD AVE	CHARLESTON	WV	Active
DSH510022FY	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Telemedicine Hubs - Telemedicine Pocahontas	150 Duncan Road	Buckeye	WV	Active
DSH510022FZ	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Telemedicine Hubs - Telemedicine Princeton	150 Courthouse Road	Princeton	WV	Active
DSH510022G	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC URGENT CARE	314 GOFF MOUNTAIN ROAD	CROSS LANES	WV	Active
DSH510022GA	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC SLEEP CENTER RIPLEY - Ohio Valley Sleep Center	300 CLAY LICK RD	RIPLEY	WV	Active
DSH510022GB	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC PEDIATRIC SPECIALISTS TV - Pediatric GI - Teays Valley	3948 TEAYS VALLEY RD	HURRICANE	WV	Active
DSH510022GC	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC CANCER & INFUSION CENTER TV - Cancer Center Teays	1401 Hospital Drive	HURRICANE	WV	Active
DSH510022GD	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Interventional Radiology - Interventional Radiology	3200 MacCorkle Avenue	Charleston	WV	Active
DSH510022GE	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC PRIMARY CARE POCA - Primary Care Poca	2851 CHARLESTON RD	POCA	WV	Active
DSH510022GF	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC THORACIC & ESOPHAGEAL SURGERY - Thoracic Surgery	3100 MACCORKLE AVE SE	CHARLESTON	WV	Active
DSH510022GG	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	Rural Health Clinic - Primary Care Summersville	702 Professional Park Drive	Summersville	WV	Active
DSH510022GH	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Ryan White Clinic - Beckley - Ryan White Clinic - Beckley	1838 Harper Rd	Beckley	WV	Active
DSH510022GJ	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC PEDIATRIC SPECIALISTS TV - Pediatric Pulmonology - TV	3948 TEAYS VALLEY RD	HURRICANE	WV	Active
DSH510022GK	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC CANCER CENTER - BECKLEY - Beckley Cancer	275 DRY HILL RD	BECKLEY	WV	Active
DSH510022H	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC WOUND HEALING CENTER	600 MORRIS STREET	CHARLESTON	WV	Active
DSH510022J	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Breast Center	3415 MacCorkle Ave SE	Charleston	WV	Active
DSH510022K	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Emergency Room	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022L	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Operating Room	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022M	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Anesthesia	3200 MacCorkle Ave SE	Charleston	WV	Active
DSH510022N	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Cardiac Cath Lab	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022P	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Non Invasive Vascular Lab	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022Q	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Vascular Center of Excellence	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022R	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Lab CDL	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022S	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Pulmonary Function	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022T	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Pulmonary Rehab	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022U	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Cancer Services	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022V	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Ambulatory Infusion Center	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022W	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Respiratory Care	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022X	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial Radiology	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022Y	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial CT Scan	3200 MacCorkle Avenue SE	Charleston	WV	Active
DSH510022Z	Child	DSH	CHARLESTON AREA MEDICAL CENTER (CAMC)	CAMC Memorial CT Scan Cardiology	3200 MacCorkle Avenue SE	Charleston	WV	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Sayre, Brian Chief Pharmacy Officer Charleston Area Medical Center 3043888917	Sayre, Brian VP of Pharmacy Services Vandalia Health 3043888917	1/6/2025 10:50 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	0001342000 (WV)		10/31/2024 3:29 PM
Details	Last Recertification Date	Update	Recertification	8/14/2023 7:30:16 PM	8/22/2024 11:13:51 AM	8/22/2024 11:13 AM
Addresses	Shipping Address	Insert	Change Request		CAMC Pharmacy #4 3948 Teays Valley Road Hurricane, WV 25526	8/5/2024 2:50 PM
Addresses	Shipping Address	Insert	Change Request		CAMC Pharmacy #5 400 Association Drive Charleston, WV 25311-1295	8/5/2024 2:50 PM
Addresses	Shipping Address	Delete	Change Request	CAMC Infectious Disease - MSOB 3100 MacCorkle Ave., S.E. Suite 604 Charleston, WV 25304		8/5/2024 2:50 PM
Contacts	Primary Contact	Update	Profile Change Request	Sayre, Brian Health System Director of Pharmacy Charleston Area Medical Center 3043888917	Sayre, Brian Chief Pharmacy Officer Charleston Area Medical Center 3043888917	6/28/2024 10:34 AM
Details	Last Recertification Date	Update	Recertification	8/26/2022 2:13:09 PM	8/14/2023 7:30:16 PM	8/14/2023 7:30 PM
Details	Last Recertification Date	Update	Recertification	9/3/2021 9:32:02 AM	8/26/2022 2:13:09 PM	8/26/2022 2:13 PM
Contacts	Authorizing Official	Update	AO Change Request	BELL, STEPHEN VICE PRESIDENT - FINANCE Charleston Area Medical Center 3043886251	Sandene, Jeff D EVP CFO CAMC Health System 3043887603	6/30/2022 2:29 PM
Details	Last Recertification Date	Update	Recertification	9/10/2020 4:43:38 PM	9/3/2021 9:32:02 AM	9/3/2021 9:32 AM
Addresses	Shipping Address	Insert	Change Request		CAMC Pharmacy #2 501 Morris St. Charleston, WV 25301	1/28/2021 10:44 AM
Contacts	Primary Contact	Update	Profile Change Request	Sayre, Brian Health System Director of Pharmacy Charelston Area Medical Center 3043888917	Sayre, Brian Health System Director of Pharmacy Charleston Area Medical Center 3043888917	1/27/2021 2:57 PM
Medicaid Billing	NPI: State	Update	Recertification		WV	9/10/2020 4:43 PM
Details	Last Recertification Date	Update	Recertification	9/6/2019 11:40:57 AM	9/10/2020 4:43:38 PM	9/10/2020 4:43 PM
Details	Last Recertification Date	Update	Recertification	8/29/2018 4:01:27 PM	9/6/2019 11:40:57 AM	9/6/2019 11:40 AM
Addresses	Shipping Address	Insert	Change Request		CAMC Memorial Hospital Pharmacy 3200 MacCorkle Ave SE Charleston, WV 25304	10/9/2018 10:24 AM
Addresses	Shipping Address	Delete	Recertification	CAMC Pharmacy #2 314 Goff Mountain Road Suite 5 Cross Lanes, WV 25313		8/29/2018 4:01 PM
Details	Last Recertification Date	Update	Recertification	11/13/2017 11:35:09 AM	8/29/2018 4:01:27 PM	8/29/2018 4:01 PM
Details	Entity Name	Update	Recertification	CHARLESTON AREA MEDICAL CENTER INC.	CHARLESTON AREA MEDICAL CENTER (CAMC)	11/16/2017 10:53 AM
Details	Last Recertification Date	Update	Recertification	8/18/2016 12:00:00 AM	11/13/2017 11:35:09 AM	11/13/2017 11:35 AM
Contacts	Authorizing Official	Update		BELL, STEPHEN VICE PRESIDENT - FINANCE 3043886251	BELL, STEPHEN VICE PRESIDENT - FINANCE Charleston Area Medical Center 3043886251	10/20/2017 1:16 PM
Contacts	Primary Contact	Update		Sayre, Brian Health System Director of Pharmacy 3043888917	Sayre, Brian Health System Director of Pharmacy Charelston Area Medical Center 3043888917	10/9/2017 9:55 AM
Contacts	Authorizing Official	Insert			BELL, STEPHEN VICE PRESIDENT - FINANCE 3043886251	7/28/2017 6:19 PM
Contacts	Primary Contact	Insert			Sayre, Brian Health System Director of Pharmacy 3043888917	7/28/2017 6:19 PM
Contacts	Signed By	Insert			HUDSON, LARRY EXECUTIVE VICE PRESIDENT AND CFO 3043887603	7/28/2017 6:19 PM
Addresses	Main Address	Insert			3200 MacCorkle Avenue, S.E. Charleston, WV 25304	7/28/2017 6:19 PM
Addresses	Shipping Address	Insert			CAMC Infectious Disease 3200 MacCorkle Avenue, S.E. Charleston, WV 25304	7/28/2017 6:19 PM
Addresses	Shipping Address	Insert			CAMC Infectious Disease - MSOB 3100 MacCorkle Ave., S.E. Suite 604 Charleston, WV 25304	7/28/2017 6:19 PM
Addresses	Shipping Address	Insert			CAMC Pharmacy 3200 MacCorkle Ave SE Charleston, WV 25304	7/28/2017 6:19 PM
Addresses	Shipping Address	Insert			CAMC Pharmacy #2 314 Goff Mountain Road Suite 5 Cross Lanes, WV 25313	7/28/2017 6:19 PM
Addresses	Shipping Address	Insert			CAMC Pharmacy #3 3415 MacCorkle Ave SE Charleston, WV 25304	7/28/2017 6:19 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/18/2016 9:42 AM
Medicaid Billing	Medicaid: Number	Insert			0001342000	8/18/2016 9:42 AM
Medicaid Billing	Medicaid: State	Insert			WV	8/18/2016 9:42 AM
Medicaid Billing	NPI: Number	Insert			1952390239	8/18/2016 9:42 AM
Details	Last Recertification Date	Update			8/18/2016 12:00:00 AM	8/18/2016 9:42 AM
Dates	Participating Approval Date	Update			4/21/2016 12:00:00 AM	4/21/2016 1:03 PM
Details	State	Update		Pending	Active	4/21/2016 1:03 PM
Dates	Start Date	Update			7/1/2016 12:00:00 AM	4/21/2016 1:03 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_60593	DSH510022CH	4/19/2016 2:20 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_60593	4/15/2016 2:47 PM
Details	Last Recertification Date	Insert				4/15/2016 2:47 PM
Details	Grant Number	Insert				4/15/2016 2:47 PM
Details	340B ID	Insert				4/15/2016 2:47 PM
Details	Is Authorizing Official EHB Data	Insert				4/15/2016 2:47 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/15/2016 2:47 PM
Details	Medicare Provider Number	Insert			510022	4/15/2016 2:47 PM
Details	Entity Name	Insert			CHARLESTON AREA MEDICAL CENTER INC.	4/15/2016 2:47 PM
Details	Program Code	Insert			DSH	4/15/2016 2:47 PM
Details	Entity Subname	Insert			CAMC Infectious Disease	4/15/2016 2:47 PM
Dates	Participating Approval Date	Insert				4/15/2016 2:47 PM
Details	State	Insert			Pending	4/15/2016 2:47 PM
Dates	Registration Date	Insert			4/15/2016 12:00:00 AM	4/15/2016 2:47 PM
Dates	Signed By Date	Insert			4/15/2016 12:00:00 AM	4/15/2016 2:47 PM
Dates	Start Date	Insert				4/15/2016 2:47 PM
Terminations	Termination Comments	Insert				4/15/2016 2:47 PM
Terminations	Termination Date	Insert				4/15/2016 2:47 PM
Terminations	Termination Effective Date	Insert				4/15/2016 2:47 PM
Terminations	Termination Reason	Insert				4/15/2016 2:47 PM