| Addresses | Shipping Address | Insert | Change Request | | Shenandoah Pharmacy – Winchester
1330 Amherst Street
Attn: Pharmacy
Winchester, VA 22601 | 4/11/2025 11:54 AM |
| Details | Last Recertification Date | Update | Recertification | 2/15/2024 8:22:52 AM | 2/28/2025 2:50:37 PM | 2/28/2025 2:50 PM |
| Addresses | Shipping Address | Delete | Recertification | Shenandoah Pharmacy
99 Tavern Road
Martinsburg, WV 25401 | | 2/15/2024 8:22 AM |
| Addresses | Shipping Address | Insert | Recertification | | Shenandoah Pharmacy
99 Tavern Road
Attn: Pharmacy
Martinsburg, WV 25401 | 2/15/2024 8:22 AM |
| Details | Last Recertification Date | Update | Recertification | 2/15/2023 10:44:27 AM | 2/15/2024 8:22:52 AM | 2/15/2024 8:22 AM |
| Addresses | Shipping Address | Update | Change Request | Shenandoah Pharmacy
99 Tavern Road
Martinsburg, WV 25401-2890 | Shenandoah Pharmacy
99 Tavern Road
Martinsburg, WV 25401 | 3/16/2023 10:08 AM |
| Addresses | Main Address | Update | Change Request |
99 Tavern Road
Martinsburg, WV 25401-2890 |
99 Tavern Road
Martinsburg, WV 25401 | 3/16/2023 10:08 AM |
| Addresses | Billing Address | Update | Recertification | SHENANDOAH VALLEY MEDICAL SYSTEM, INC.
PO BOX 1146
Martinsburg, WV 25401-1146 | SHENANDOAH VALLEY MEDICAL SYSTEM, INC.
PO BOX 1146
Martinsburg, WV 25402 | 2/15/2023 10:44 AM |
| Details | Last Recertification Date | Update | Recertification | 2/9/2022 2:52:41 PM | 2/15/2023 10:44:27 AM | 2/15/2023 10:44 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Hassing, Michael
CEO
Shenandoah Valley Medical System, Inc
3045962610-1062 | Hassing, Michael
CEO
Shenandoah Valley Medical System, Incorporated
3045962610-1062 | 10/27/2022 10:12 AM |
| Details | Last Recertification Date | Update | Recertification | 2/18/2021 8:25:55 AM | 2/9/2022 2:52:41 PM | 2/9/2022 2:52 PM |
| Addresses | Main Address | Update | Recertification |
99 Tavern Rd
Martinsburg, WV 25401-2890 |
99 Tavern Road
Martinsburg, WV 25401-2890 | 2/18/2021 8:25 AM |
| Details | Last Recertification Date | Update | Recertification | 2/7/2020 2:29:04 PM | 2/18/2021 8:25:55 AM | 2/18/2021 8:25 AM |
| Contacts | Primary Contact | Update | Change Request | Estes, Benjamin
Pharmacist in Charge
Shenandoah Valley Medical System, Inc.
3045962244-1042 | McCahan, Stephen W
Pharmacy Director
Shenandoah Valley Medical System, Inc
3045962244 | 5/8/2020 1:12 PM |
| Details | Last Recertification Date | Update | Recertification | 2/19/2019 1:34:26 PM | 2/7/2020 2:29:04 PM | 2/7/2020 2:29 PM |
| Addresses | Shipping Address | Delete | Change Request | Shenandoah Pharmacy
99 Tavern Road
Martinsburg, WV 25401 | | 5/21/2019 11:10 AM |
| Addresses | Billing Address | Insert | Change Request | | SHENANDOAH VALLEY MEDICAL SYSTEM, INC.
PO BOX 1146
Martinsburg, WV 25401-1146 | 5/21/2019 11:10 AM |
| Addresses | Shipping Address | Insert | Change Request | | Shenandoah Pharmacy
99 Tavern Road
Martinsburg, WV 25401-2890 | 5/21/2019 11:10 AM |
| Details | Entity Subname | Update | Change Request | SCHC MOBILE MEDICAL VAN | SCH Mobile | 5/21/2019 11:10 AM |
| Addresses | Shipping Address | Insert | Recertification | | Shenandoah Pharmacy
99 Tavern Road
Martinsburg, WV 25401 | 2/19/2019 1:34 PM |
| Details | Last Recertification Date | Update | Recertification | 2/16/2018 10:54:44 AM | 2/19/2019 1:34:26 PM | 2/19/2019 1:34 PM |
| Contacts | Primary Contact | Update | Recertification | FANT, DAVID
CEO
SVMS
3042634999-1062 | Estes, Benjamin
Pharmacist in Charge
Shenandoah Valley Medical System, Inc.
3045962244-1042 | 2/16/2018 10:54 AM |
| Details | Last Recertification Date | Update | Recertification | 1/26/2017 12:00:00 AM | 2/16/2018 10:54:44 AM | 2/16/2018 10:54 AM |
| Details | Is Authorizing Official EHB Data | Update | Recertification | False | | 2/16/2018 10:54 AM |
| Contacts | Authorizing Official | Update | AO Change Request | FANT, DAVID
CEO
SVMS
3042634999-1062 | Hassing, Michael
CEO
Shenandoah Valley Medical System, Inc
3045962610-1062 | 2/12/2018 7:36 AM |
| Contacts | Authorizing Official | Update | | FANT, DAVID
CEO
3042634999-1062 | FANT, DAVID
CEO
SVMS
3042634999-1062 | 1/11/2018 11:06 AM |
| Contacts | Primary Contact | Update | | FANT, DAVID
CEO
3042634999-1062 | FANT, DAVID
CEO
SVMS
3042634999-1062 | 1/11/2018 11:06 AM |
| Contacts | Signed By | Update | | FANT, DAVID
CEO
3042634999-1062 | FANT, DAVID
CEO
SVMS
3042634999-1062 | 1/11/2018 11:06 AM |
| Addresses | Main Address | Insert | | |
99 Tavern Rd
Martinsburg, WV 25401-2890 | 1/26/2017 10:03 AM |
| Contacts | Authorizing Official | Insert | | | FANT, DAVID
CEO
3042634999-1062 | 1/26/2017 10:03 AM |
| Contacts | Primary Contact | Insert | | | FANT, DAVID
CEO
3042634999-1062 | 1/26/2017 10:03 AM |
| Contacts | Signed By | Insert | | | FANT, DAVID
CEO
3042634999-1062 | 1/26/2017 10:03 AM |
| Details | Last Recertification Date | Update | | | 1/26/2017 12:00:00 AM | 1/26/2017 10:03 AM |
| Dates | Participating Approval Date | Update | | | 7/29/2016 12:00:00 AM | 7/29/2016 10:44 AM |
| Details | State | Update | | Pending | Active | 7/29/2016 10:44 AM |
| Dates | Start Date | Update | | | 10/1/2016 12:00:00 AM | 7/29/2016 10:44 AM |
| Details | 340B ID | Update | | CH03090Q | CH03090P | 7/19/2016 10:30 AM |
| Details | 340B ID | Update | | ONLINE_REG_71988 | CH03090Q | 7/19/2016 10:26 AM |
| Details | 340B ID | Update | | ONLINE_REG | ONLINE_REG_71988 | 7/15/2016 1:57 PM |
| Details | Last Recertification Date | Insert | | | | 7/15/2016 1:57 PM |
| Details | Grant Number | Insert | | | H80CS00781 | 7/15/2016 1:57 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 7/15/2016 1:57 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | False | 7/15/2016 1:57 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/15/2016 1:57 PM |
| Details | Medicare Provider Number | Insert | | | | 7/15/2016 1:57 PM |
| Details | Entity Name | Insert | | | SHENANDOAH VALLEY MEDICAL SYSTEM, INCORPORATED | 7/15/2016 1:57 PM |
| Details | Program Code | Insert | | | CH | 7/15/2016 1:57 PM |
| Details | Entity Subname | Insert | | | SCHC MOBILE MEDICAL VAN | 7/15/2016 1:57 PM |
| Dates | Participating Approval Date | Insert | | | | 7/15/2016 1:57 PM |
| Details | State | Insert | | | Pending | 7/15/2016 1:57 PM |
| Dates | Registration Date | Insert | | | 7/15/2016 12:00:00 AM | 7/15/2016 1:57 PM |
| Dates | Signed By Date | Insert | | | 7/15/2016 12:00:00 AM | 7/15/2016 1:57 PM |
| Dates | Start Date | Insert | | | | 7/15/2016 1:57 PM |
| Terminations | Termination Comments | Insert | | | | 7/15/2016 1:57 PM |
| Terminations | Termination Date | Insert | | | | 7/15/2016 1:57 PM |
| Terminations | Termination Effective Date | Insert | | | | 7/15/2016 1:57 PM |
| Terminations | Termination Reason | Insert | | | | 7/15/2016 1:57 PM |