Covered Entity Details

CAH341315-04 Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital (Active) - information as of 4/25/2025 8:32:42 PM

Main Details

Name

Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital

Subdivision Name

CAPE FEAR VALLEY-BLADEN MEDICAL EXP

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH341315-04

Medicare Provider Number

341315

Outpatient Facility Provider Number

343449

Additional Details

Current Program Status

Active

Registration Date

10/11/2016

Participating Start Date

1/1/2017

Participating Approval Date

12/8/2016

Last Recertification Date

8/16/2024

Contacts

Authorizing Official

Bladen County Hospital
Spencer Lowell Cummings, President
(910) 862-5149

Primary Contact

Bladen Healthcare, LLC dba CFVHS-Bladen County Hospital
Karen Gentry, Pharmacy Director
(910) 862-5157

Addresses

Street Address

107 EAST DUNHAM ST
ELIZABETHTOWN, NC 28337-9375

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
NC	1114269677	1114269677

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
CAH341315-01	Child	CAH	Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital	CAPE FEAR VALLEY BLADEN MEDICAL	16 3RD ST	DUBLIN	NC	Active
CAH341315-02	Child	CAH	Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital	CAPE FEAR VALLEY-BLADEN MEDICAL ASS	1106 W SEABOARD STREET	BLADENBORO	NC	Active
CAH341315-03	Child	CAH	Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital	CAPE FEAR VALLEY - BLADEN MEDICAL A	300 A EAST MCKAY STREET	ELIZABETHTOWN	NC	Active
CAH341315-04	Child	CAH	Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital	CAPE FEAR VALLEY-BLADEN MEDICAL EXP	107 EAST DUNHAM ST	ELIZABETHTOWN	NC	Active
CAH341315-05	Child	CAH	Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital	CFV BLADEN MEDICAL ASSOCIATES - Family medicine practice	9858 WR Lathan Drive	CLARKTON	NC	Active
CAH341315-06	Child	CAH	Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital	CFV BLADEN MEDICAL ASSOCIATES - BMA White Lake	273 WHITE LAKE DR	ELIZABETHTOWN	NC	Active
CAH341315-07	Child	CAH	Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital	CFV PRIMARY CARE-VINELAND FAMILY ME - Family Medicine	630 S MADISON ST	WHITEVILLE	NC	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 9:24:33 AM	8/16/2024 2:53:47 PM	8/16/2024 2:53 PM
Contacts	Authorizing Official	Update	AO Change Request	Fife, Stephen President & CFO Bladen Healthcare, LLC 9108625149	Cummings, Spencer Lowell President Bladen County Hospital 9108625149	10/12/2023 11:35 AM
Details	Last Recertification Date	Update	Recertification	8/31/2022 3:12:59 PM	8/15/2023 9:24:33 AM	8/15/2023 9:24 AM
Details	Last Recertification Date	Update	Recertification	8/26/2021 1:30:58 PM	8/31/2022 3:12:59 PM	8/31/2022 3:12 PM
Details	Last Recertification Date	Update	Recertification	8/31/2020 9:15:51 AM	8/26/2021 1:30:58 PM	8/26/2021 1:30 PM
Contacts	Authorizing Official	Update	Profile Change Request	Fife, Stephen Director of Finance Bladen Healthcare, LLC 9108625149	Fife, Stephen President & CFO Bladen Healthcare, LLC 9108625149	10/14/2020 7:59 AM
Medicaid Billing	NPI: State	Update	Recertification		NC	8/31/2020 9:15 AM
Details	Last Recertification Date	Update	Recertification	8/26/2019 4:21:55 PM	8/31/2020 9:15:51 AM	8/31/2020 9:15 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/5/2020 10:39 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1114269677	3/5/2020 10:39 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	3/5/2020 10:39 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1114269677	3/5/2020 10:39 AM
Contacts	Authorizing Official	Update	Change Request	Cobb, Mark Wilson President Bladen Healthcare, LLC dba CFVHS-Bladen County Hospital 9108625178	Fife, Stephen Director of Finance Bladen Healthcare, LLC 9108625149	12/9/2019 9:27 AM
Details	Last Recertification Date	Update	Recertification	8/22/2018 9:58:51 AM	8/26/2019 4:21:55 PM	8/26/2019 4:21 PM
Contacts	Authorizing Official	Update	AO Change Request	Wells, Roxie Cannon President Cape Fear Valley Bladen County Hospital 9108625179	Cobb, Mark Wilson President Bladen Healthcare, LLC dba CFVHS-Bladen County Hospital 9108625178	8/21/2019 3:04 PM
Details	Last Recertification Date	Update	Recertification	11/14/2017 9:02:53 AM	8/22/2018 9:58:51 AM	8/22/2018 9:58 AM
Details	Entity Name	Update	Recertification	BLADEN COUNTY HOSPITAL	Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital	11/15/2017 1:14 PM
Details	Last Recertification Date	Update	Recertification		11/14/2017 9:02:53 AM	11/14/2017 9:02 AM
Contacts	Authorizing Official	Insert	AO Change Request		Wells, Roxie Cannon President Cape Fear Valley Bladen County Hospital 9108625179	11/13/2017 7:16 AM
Contacts	Primary Contact	Update		Gentry, Karen Pharmacy Director 9108625157	Gentry, Karen Pharmacy Director Bladen Healthcare, LLC dba CFVHS-Bladen County Hospital 9108625157	9/22/2017 10:00 AM
Contacts	Primary Contact	Insert			Gentry, Karen Pharmacy Director 9108625157	12/8/2016 2:07 PM
Contacts	Signed By	Insert			Wells, Roxie President 9108625179	12/8/2016 2:07 PM
Addresses	Main Address	Insert			107 EAST DUNHAM ST ELIZABETHTOWN, NC 28337-9375	12/8/2016 2:07 PM
Dates	Participating Approval Date	Update			12/8/2016 12:00:00 AM	12/8/2016 2:06 PM
Details	State	Update		Pending	Active	12/8/2016 2:06 PM
Dates	Start Date	Update			1/1/2017 12:00:00 AM	12/8/2016 2:06 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_72859	CAH341315-04	10/25/2016 11:25 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_72859	10/11/2016 1:54 PM
Details	Last Recertification Date	Insert				10/11/2016 1:54 PM
Details	Grant Number	Insert				10/11/2016 1:54 PM
Details	340B ID	Insert				10/11/2016 1:54 PM
Details	Is Authorizing Official EHB Data	Insert				10/11/2016 1:54 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/11/2016 1:54 PM
Details	Medicare Provider Number	Insert			341315	10/11/2016 1:54 PM
Details	Entity Name	Insert			BLADEN COUNTY HOSPITAL	10/11/2016 1:54 PM
Details	Program Code	Insert			CAH	10/11/2016 1:54 PM
Details	Entity Subname	Insert			CAPE FEAR VALLEY-BLADEN MEDICAL EXP	10/11/2016 1:54 PM
Dates	Participating Approval Date	Insert				10/11/2016 1:54 PM
Details	State	Insert			Pending	10/11/2016 1:54 PM
Dates	Registration Date	Insert			10/11/2016 12:00:00 AM	10/11/2016 1:54 PM
Dates	Signed By Date	Insert			10/11/2016 12:00:00 AM	10/11/2016 1:54 PM
Dates	Start Date	Insert				10/11/2016 1:54 PM
Terminations	Termination Comments	Insert				10/11/2016 1:54 PM
Terminations	Termination Date	Insert				10/11/2016 1:54 PM
Terminations	Termination Effective Date	Insert				10/11/2016 1:54 PM
Terminations	Termination Reason	Insert				10/11/2016 1:54 PM