Covered Entity Details

CH03082G MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INC (Terminated) - information as of 5/4/2025 10:28:05 PM

Main Details

Name

MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INC

Subdivision Name

MVA Health Center: Monongah Elementary School Wellness Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-017488

340B ID

CH03082G

Grant Number

H80CS00383

Additional Details

Current Program Status

Terminated

Registration Date

7/3/2017

Participating Start Date

10/1/2017

Participating Approval Date

7/11/2017

Last Recertification Date

2/7/2022

Termination Date
Termination Reason

4/1/2023
Business decision by the Covered Entity

Contacts

Authorizing Official

MVA Health Centers, Inc.
NANCY L. VANDERGRIFT, CEO
(304) 367-8740

Primary Contact

MVA Health Centers, Inc
Kayetlyn Mary Dawn Edinger, Manager of Operations, 340B Coordinator
(304) 367-8628

Addresses

Street Address

628 Walnut Street
Monongah, WV 26554

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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		1770697278

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.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH030820	Active	BPS-H80-001384	MONONGAHELA VALLEY ASN HLTH CTRS	MVA Health Center - Fairmont	1322 LOCUST AVENUE	FAIRMONT	WV
CH03082B	Active	BPS-H80-005082	MONONGAHELA VALLEY ASN HLTH CTRS	MVA Health Center - Shinnston	1 COLUMBIA ROAD	SHINNSTON	WV
CH03082C	Active	BPS-H80-004389	MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INC	MVA Health Center - North Marion High School Wellness Center	1 N Marion Dr	Farmington	WV
CH03082D	Active	BPS-H80-000771	MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INC	MVA Health Center - East Fairmont High School Wellness Center	1993 Airport Rd	Fairmont	WV
CH03082E	Active	BPS-H80-010108	MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INC	MVA Health Center - Pediatrics	1338 Locust Ave	Fairmont	WV
CH03082F	Active	BPS-H80-018585	MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INC	MVA Health Center - Mannington	118 Market Street	Mannington	WV
CH03082G	Terminated	BPS-H80-017488	MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INC	MVA Health Center: Monongah Elementary School Wellness Center	628 Walnut Street	Monongah	WV
CH03082H	Terminated	BPS-H80-017489	MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INC	MVA Health Center: Monongah Middle School Wellness Center	550 Camden Avenue	Monongah	WV
CH03082J	Terminated	BPS-H80-022241	MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INC	MVA Health Center - East Fairmont Middle School Wellness Center	221 Mason Street	Fairmont	WV
CH03082K	Terminated	BPS-H80-022243	MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INC	MVA Health Center - West Fairmont Middle School Wellness Center	110 10th Street	Fairmont	WV

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH030820	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/01/2018
CH030820	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	04/01/2018	10/01/2022
CH030820	RIDER PHARMACY	RIDER PHARMACY	303 MERCHANT STREET	FAIRMONT	WV	26554-2655	07/01/2018	12/15/2019
CH030820	RITE AID OF WEST VIRGINIA, INC.	RITE AID #2799	627 FAIRMONT AVENUE	FAIRMONT	WV	26554	04/01/2017	02/09/2018
CH030820	RITE AID OF WEST VIRGINIA, INC.	RITE AID #917	208 S. PIKE STREET	SHINNSTON	WV	26431	04/01/2017	02/09/2018
CH030820	RITE AID OF WEST VIRGINIA, INC.	RITE AID #1408	109 EAST MAIN STREET	MANNINGTON	WV	26582	04/01/2017	02/09/2018
CH030820	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH030820	WAL-MART PHARMACY 10-1714	32 TYGART MALL LOOP		FAIRMONT	WV	26554	04/01/2017
CH03082D	WAL-MART PHARMACY 10-1714	32 TYGART MALL LOOP		FAIRMONT	WV	26554	04/01/2024
CH030820	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH030820	WALGREEN CO.	WALGREENS #18959	109 E MAIN ST	MANNINGTON	WV	26582-1126	02/27/2018
CH030820	WALGREEN CO.	WALGREENS #19094	208 S PIKE ST.	SHINNSTON	WV	26431-1122	02/27/2018
CH030820	WALGREEN CO.	WALGREENS #19258	627 FAIRMONT AVE	FAIRMONT	WV	26554-5103	02/27/2018
CH03082F	WALGREEN CO.	WALGREENS #18959	109 E MAIN ST	MANNINGTON	WV	26582-1126	04/01/2024
CH03082B	WALGREEN CO.	WALGREENS #19094	208 S PIKE ST.	SHINNSTON	WV	26431-1122	04/01/2024
CH030820	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	04/01/2024
CH030820	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/01/2018	01/11/2024
CH030820	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/01/2018
CH030820	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/01/2018
CH030820	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/01/2018
CH030820	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CH030820	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	07/01/2024
CH030820	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04021	401 MARION SQUARE	FAIRMONT	WV	26554	04/01/2017
CH030820	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03475	300 FAIRMONT AVENUE	FAIRMONT	WV	26554	04/01/2017
CH030820	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05955	2 RAINBOW PLAZA	MANNINGTON	WV	26582	07/01/2019
CH030820	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03186	701 E. MAIN STREET	CLARKSBURG	WV	26301	01/01/2021
CH03082C	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05955	2 RAINBOW PLAZA	MANNINGTON	WV	26582	04/01/2024
CH03082E	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04021	401 MARION SQUARE	FAIRMONT	WV	26554	04/01/2024
CH030820	WHITE HALL PHARMACY, LLC.	177 MIDDLETOWN RD STE 2		FAIRMONT	WV	26554-8254	07/01/2020

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2023 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		2/28/2023 12:00:00 AM	2/28/2023 2:17 PM
Details	State	Update	Recertification	Active	To Be Terminated	2/28/2023 2:17 PM
Terminations	Termination Comments	Update	Recertification		During COVID, school based health centers declined sharply, and now guidelines have changed. This has left MVA only hosting wellness centers within the high schools in the area.	2/28/2023 2:17 PM
Terminations	Termination Date	Update	Recertification		4/1/2023 12:00:00 AM	2/28/2023 2:17 PM
Terminations	Termination Effective Date	Update	Recertification		3/1/2023 12:00:00 AM	2/28/2023 2:17 PM
Terminations	Termination Reason	Update	Recertification		Business decision by the Covered Entity	2/28/2023 2:17 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770697278	2/7/2022 12:17 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	2/7/2022 12:17 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1285093039 (WV)		2/7/2022 12:17 PM
Details	Last Recertification Date	Update	Recertification	2/4/2021 7:52:11 AM	2/7/2022 12:17:18 PM	2/7/2022 12:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1285093039 (WV)		8/2/2021 4:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/9/2021 1:32 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1285093039	6/9/2021 1:32 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WV	6/9/2021 1:32 PM
Medicaid Billing	NPI: State	Update	Recertification		WV	2/4/2021 7:52 AM
Contacts	Primary Contact	Update	Recertification	Crockett, Kevin Vice President/COO MVA Health Centers, Inc. 3043678740	Edinger, Kayetlyn Mary Dawn Manager of Operations, 340B Coordinator MVA Health Centers, Inc 3043678628	2/4/2021 7:52 AM
Details	Last Recertification Date	Update	Recertification	1/29/2020 9:38:07 AM	2/4/2021 7:52:11 AM	2/4/2021 7:52 AM
Details	Last Recertification Date	Update	Recertification	1/29/2019 12:26:36 PM	1/29/2020 9:38:07 AM	1/29/2020 9:38 AM
Details	Last Recertification Date	Update	Recertification	3/1/2018 2:53:44 PM	1/29/2019 12:26:36 PM	1/29/2019 12:26 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1285093039 (WV)		3/1/2018 2:53 PM
Details	Last Recertification Date	Update	Recertification		3/1/2018 2:53:44 PM	3/1/2018 2:53 PM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		3/1/2018 2:53 PM
Contacts	Authorizing Official	Update		VANDERGRIFT, NANCY L. CEO 3043678740	VANDERGRIFT, NANCY L. CEO MVA Health Centers, Inc. 3043678740	10/9/2017 12:21 PM
Contacts	Signed By	Update		VANDERGRIFT, NANCY L. CEO 3043678740	VANDERGRIFT, NANCY L. CEO MVA Health Centers, Inc. 3043678740	10/9/2017 12:21 PM
Contacts	Primary Contact	Update		Crockett, Kevin Vice President/COO 3043678740	Crockett, Kevin Vice President/COO MVA Health Centers, Inc. 3043678740	9/29/2017 8:17 AM
Contacts	Authorizing Official	Insert			VANDERGRIFT, NANCY L. CEO 3043678740	7/26/2017 11:54 AM
Contacts	Signed By	Insert			VANDERGRIFT, NANCY L. CEO 3043678740	7/26/2017 11:54 AM
Contacts	Primary Contact	Insert			Crockett, Kevin Vice President/COO 3043678740	7/11/2017 7:07 PM
Addresses	Main Address	Insert			628 Walnut Street Monongah, WV 26554	7/11/2017 7:07 PM
Details	State	Update		Approved	Active	7/11/2017 7:07 PM
Dates	Participating Approval Date	Update			7/11/2017 12:00:00 AM	7/11/2017 7:06 PM
Details	State	Update		Pending	Approved	7/11/2017 7:06 PM
Dates	Start Date	Update			10/1/2017 12:00:00 AM	7/11/2017 7:06 PM
Details	340B ID	Update		ONLINE_REG_77663	CH03082G	7/6/2017 11:25 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_77663	7/3/2017 10:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/3/2017 10:42 AM
Medicaid Billing	Medicaid: Number	Insert			1285093039	7/3/2017 10:42 AM
Medicaid Billing	Medicaid: State	Insert			WV	7/3/2017 10:42 AM
Medicaid Billing	NPI: Number	Insert			1285093039	7/3/2017 10:42 AM
Details	Last Recertification Date	Insert				7/3/2017 10:42 AM
Details	Grant Number	Insert			H80CS00383	7/3/2017 10:42 AM
Details	340B ID	Insert			ONLINE_REG	7/3/2017 10:42 AM
Details	Is Authorizing Official EHB Data	Insert			False	7/3/2017 10:42 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/3/2017 10:42 AM
Details	Medicare Provider Number	Insert				7/3/2017 10:42 AM
Details	Entity Name	Insert			MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INC	7/3/2017 10:42 AM
Details	Program Code	Insert			CH	7/3/2017 10:42 AM
Details	Entity Subname	Insert			MVA Health Center: Monongah Elementary School Wellness Center	7/3/2017 10:42 AM
Dates	Participating Approval Date	Insert				7/3/2017 10:42 AM
Details	State	Insert			Pending	7/3/2017 10:42 AM
Dates	Registration Date	Insert			7/3/2017 12:00:00 AM	7/3/2017 10:42 AM
Dates	Signed By Date	Insert			7/3/2017 12:00:00 AM	7/3/2017 10:42 AM
Dates	Start Date	Insert				7/3/2017 10:42 AM
Terminations	Termination Comments	Insert				7/3/2017 10:42 AM
Terminations	Termination Date	Insert				7/3/2017 10:42 AM
Terminations	Termination Effective Date	Insert				7/3/2017 10:42 AM
Terminations	Termination Reason	Insert				7/3/2017 10:42 AM

340B Drug Pricing Program Database