Covered Entity Details

DSH510029AA Thomas Memorial Hospital (Terminated) - information as of 6/27/2025 12:33:06 AM

Main Details

Name

Thomas Memorial Hospital

Subdivision Name

Thomas Health Neurology on Division Street Department of Thomas Memorial Hospital

Type

Disproportionate Share Hospital

Rural

340B ID

DSH510029AA

Medicare Provider Number

510029

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/12/2018

Participating Start Date

4/1/2018

Participating Approval Date

1/30/2018

Last Recertification Date

8/28/2023

Termination Date
Termination Reason

4/1/2024
Business decision by the Covered Entity

Contacts

Authorizing Official

Thomas Health System
Jason Gizzi, VP of Finance/CFO
(304) 288-1614

Primary Contact

WVU Medicine
Colin Nelson, Senior Pharmacy Analyst
(304) 766-3606

Addresses

Street Address

424 Division Street
South Charleston, WV 25309

Billing Address

Thomas Memorial Hospital
4605 MacCorkle Avenue, SW
South Charleston, WV 25309

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	3810024049,0001391000	1316925506,1871866806

Shipping Addresses

Shipping Address 1

Thomas Memorial Hospital
4605 MacCorkle Avenue, SW
South Charleston, WV 25309

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
DSH510029A	Child	DSH	Thomas Memorial Hospital	Thomas Health Outpatient Center on Kanawha Avenue Department of Thomas Memorial Hospital	4610 Kanawha Avenue SW	South Charleston	WV	Terminated
DSH510029AA	Child	DSH	Thomas Memorial Hospital	Thomas Health Neurology on Division Street Department of Thomas Memorial Hospital	424 Division Street	South Charleston	WV	Terminated
DSH510029AB	Child	DSH	Thomas Memorial Hospital	Thomas Health General Surgery on Division Street Department of Thomas Memorial Hospital	434 Division Street	South Charleston	WV	Active
DSH510029AC	Child	DSH	Thomas Memorial Hospital	WVU Medicine Thomas Hospitals Infectious Disease	4607 MacCorkle Ave SW.	South Charleston	WV	Active
DSH510029AD	Child	DSH	Thomas Memorial Hospital	Thomas Health Primary Care on Kentucky Street Department of Thomas Memorial Hospital	4820 Kentucky Street	South Charleston	WV	Active
DSH510029AE	Child	DSH	Thomas Memorial Hospital	Thomas Health Uro-Gynecology at Thomas Memeorial Hospital - Gynecology, Urology	4607 MacCorkle Ave SW	South Charleston	WV	Active
DSH510029AF	Child	DSH	Thomas Memorial Hospital	WVU Medicine Thomas Hospitals Pulmonology - Pulmonology	4619 Kanawha Ave SW.	South Charleston	WV	Active
DSH510029AG	Child	DSH	Thomas Memorial Hospital	WVU Medicine Thomas Hospitals Nephrology - Nephrology	401 Division St.	South Charleston	WV	Active
DSH510029AJ	Child	DSH	Thomas Memorial Hospital	WVU Medicine Thomas Hospitals Primary Care Donnally St. - Primary Care	500 Donnally St	Charleston	WV	Active
DSH510029AK	Child	DSH	Thomas Memorial Hospital	SFH Outpatient Surgery - Outpatient Surgery	331 Laidley St.	Charleston	WV	Active
DSH510029AM	Child	DSH	Thomas Memorial Hospital	Spine and Nerve on Court St. - Spine and Nerve	400 Court St.	Charleston	WV	Active
DSH510029AN	Child	DSH	Thomas Memorial Hospital	One Day Surgery on Donnally St. - One Day Surgery	500 Donnally St.	Charleston	WV	Active
DSH510029AP	Child	DSH	Thomas Memorial Hospital	SFH Physical Therapy - Physical Therapy	333 Laidley St.	Charleston	WV	Active
DSH510029AQ	Child	DSH	Thomas Memorial Hospital	SFH Hyperbaric - Hyperbaric	333 Laidley St.	Charleston	WV	Active
DSH510029AR	Child	DSH	Thomas Memorial Hospital	SFH Laboratory - Laboratory	333 Laidley St.	Charleston	WV	Active
DSH510029AS	Child	DSH	Thomas Memorial Hospital	SFH Cardiac Catheterization - Cardiac Catheterization	333 Laidley St.	Charleston	WV	Active
DSH510029AT	Child	DSH	Thomas Memorial Hospital	SFH CT Scan - CT	333 Laidley St	Charleston	WV	Active
DSH510029AU	Child	DSH	Thomas Memorial Hospital	SFH Operating Room - Operating Room	333 Laidley St.	Charleston	WV	Active
DSH510029AV	Child	DSH	Thomas Memorial Hospital	SFH Radiology-Diagnostic - Radiology	333 Laidley St	Charleston	WV	Active
DSH510029AW	Child	DSH	Thomas Memorial Hospital	SFH Respiratory Therapy - Respiratory Therapy	333 Laidley St.	Charleston	WV	Active
DSH510029AX	Child	DSH	Thomas Memorial Hospital	SFH Observation 1 West - Observation	333 Laidley St.	Charleston	WV	Active
DSH510029AY	Child	DSH	Thomas Memorial Hospital	Thomas Outpatient Diagnostic Center in Spring Hill - Diagnostic Radiology	4800 Kanawha Ave SW	South Charleston	WV	Active
DSH510029AZ	Child	DSH	Thomas Memorial Hospital	Ambulatory Infusion - Infusion Services	424 Division St.	South Charleston	WV	Terminated
DSH510029B	Child	DSH	Thomas Memorial Hospital	Thomas Metro MRI	Ashton Place Shopping Center	Charleston	WV	Active
DSH510029C	Child	DSH	Thomas Memorial Hospital	Thomas Health Outpatient Surgery at Thomas Memorial Hospital	4605 MacCorkle Ave, SW	South Charleston	WV	Terminated
DSH510029D	Child	DSH	Thomas Memorial Hospital	Thomas Health Behavorial Health Outpatient at Saint Francis Hospital Department of Thomas Memorial Hospital	331 Laidley Street	Charleston	WV	Terminated
DSH510029E	Child	DSH	Thomas Memorial Hospital	Thomas Sleep Center	4619 Kanawha Ave SW	South Charleston	WV	Active
DSH510029F	Child	DSH	Thomas Memorial Hospital	Thomas Health Outpatient Center on Teays Valley Road Department of Thomas Memorial Hospital	4004 State Route 34	Hurricane	WV	Terminated
DSH510029G	Child	DSH	Thomas Memorial Hospital	Home Health Services	4825 MacCorkle Avenue, SW	South Charleston	WV	Terminated
DSH510029H	Child	DSH	THOMAS MEMORIAL HOSPITAL	Thomas Care Clinic-WVSU	301 Washington Ave Suite 004	Dunbar	WV	Terminated
DSH510029J	Child	DSH	Thomas Memorial Hospital	Thomas Care Clinic	4605 MacCorkle Ave SW	South Charleston	WV	Terminated
DSH510029K	Child	DSH	Thomas Memorial Hospital	Thomas Health Endocrinology on Poplar Street Department of Thomas Memorial Hospital	500 Poplar St	South Charleston	WV	Active
DSH510029L	Child	DSH	Thomas Memorial Hospital	TMH Family Practice Associates	500 Poplar St Suite 304	South Charleston	WV	Terminated
DSH510029M	Child	DSH	Thomas Memorial Hospital	Thomas Health Endocrinology on Division Street Department of Thomas Memorial Hospital	436 Division St	South Charleston	WV	Active
DSH510029N	Child	DSH	Thomas Memorial Hospital	Thomas Health Urology on Kanawha Avenue Department of Thomas Memorial Hospital	4610 Kanawha Ave SW Suite 401	South Charleston	WV	Active
DSH510029P	Child	DSH	Thomas Memorial Hospital	Thomas Health Hematology Oncology at Thomas Memorial Hospital	500 Poplar St.	South Charleston	WV	Active
DSH510029Q	Child	DSH	Thomas Memorial Hospital	TMH Pulmonology	401 Division St Suite 106	South Charleston	WV	Terminated
DSH510029R	Child	DSH	Thomas Memorial Hospital	Thomas Health Primary Care at Thomas Memorial Hospital	401 Division St Suite 205	South Charleston	WV	Terminated
DSH510029S	Child	DSH	Thomas Memorial Hospital	Thomas Health General Surgery on Poplar Street Department of Thomas Memorial Hospital	500 POPLAR ST SUITE 304	SOUTH CHARLESTON	WV	Active
DSH510029T	Child	DSH	Thomas Memorial Hospital	TMH UROLOGY	432 DIVISION ST	SOUTH CHARLESTON	WV	Terminated
DSH510029U	Child	DSH	Thomas Memorial Hospital	Thomas Health Primary Care in Winfield Department of Thomas Memorial Hospital	11924 WINFIELD ROAD	WINFIELD	WV	Active
DSH510029V	Child	DSH	Thomas Memorial Hospital	Thomas Health Primary Care on Division Street Department of Thomas Memorial Hospital	400 DIVISION STREET	SOUTH CHARLESTON	WV	Active
DSH510029W	Child	DSH	Thomas Memorial Hospital	Thomas Health Primary Care on Chestnut Street Department of Thomas Memorial Hospital	506 CHESTNUT STREET	SOUTH CHARLESTON	WV	Active
DSH510029X	Child	DSH	Thomas Memorial Hospital	Thomas Health Primary Care And Endocrinology at Ashton Department of Thomas Memorial Hospital	1097 FLEDDERJOHN ROAD	CHARLESTON	WV	Active
DSH510029Y	Child	DSH	Thomas Memorial Hospital	Thomas Health Urgent Care in Nitro Department of Thomas Memorial Hospital	6 BANK STREET	NITRO	WV	Active
DSH510029Z	Child	DSH	Thomas Memorial Hospital	WVU Medicine Thomas Hospitals Psychiatry	333 Laidley St 4 East	Charleston	WV	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Nelson, Colin 340B Data Specialist Thomas Health 3047663606	Nelson, Colin Senior Pharmacy Analyst WVU Medicine 3047663606	4/16/2024 7:41 AM
Details	State	Update		To Be Terminated	Terminated	4/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		7/31/2020 12:00:00 AM	3/6/2024 7:45 AM
Details	State	Update	Termination Request	Active	To Be Terminated	3/6/2024 7:45 AM
Terminations	Termination Comments	Update	Termination Request		This neurology office ceased operation when the physician left the organization. The site sat vacant in hopes we could attract a new physician to take over and was left registered. However, now a physician with a new specialty has moved in and the location does not meet criteria to be 340B eligible for our entity. Therefore, we wish to terminate this child site location.	3/6/2024 7:45 AM
Terminations	Termination Date	Update	Termination Request		4/1/2024 12:00:00 AM	3/6/2024 7:45 AM
Terminations	Termination Effective Date	Update	Termination Request		12/31/2023 12:00:00 AM	3/6/2024 7:45 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	3/6/2024 7:45 AM
Contacts	Authorizing Official	Update	Change Request	Skeldon, Timothy Chief Financial Officer Thomas Health 3047663428	Gizzi, Jason VP of Finance/CFO Thomas Health System 3042881614	3/4/2024 7:00 AM
Contacts	Primary Contact	Update	Group Change Request	Nelson, Colin 340B Data Specialist Thomas Health System 3047663606	Nelson, Colin 340B Data Specialist Thomas Health 3047663606	10/12/2023 4:13 PM
Contacts	Authorizing Official	Update	Change Request	Skeldon, Timothy Chief Financial Officer Thomas Health 3047663428	Skeldon, Timothy Chief Financial Officer Thomas Health 3047663428	10/11/2023 8:28 AM
Details	Last Recertification Date	Update	Recertification	9/5/2022 4:29:34 PM	8/28/2023 4:25:06 PM	8/28/2023 4:25 PM
Contacts	Primary Contact	Update	PC Change Request	Priddy, Ken 340B Program Director Thomas Memorial Hospital 3047664320	Nelson, Colin 340B Data Specialist Thomas Health System 3047663606	8/14/2023 12:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2023 4:45 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		3810024049	3/15/2023 4:45 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WV	3/15/2023 4:45 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2023 4:45 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0001391000	3/15/2023 4:45 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WV	3/15/2023 4:45 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1316925506	3/15/2023 4:45 PM
Medicaid Billing	NPI: State	Insert	Change Request		WV	3/15/2023 4:45 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1871866806	3/15/2023 4:45 PM
Medicaid Billing	NPI: State	Insert	Change Request		WV	3/15/2023 4:45 PM
Details	Last Recertification Date	Update	Recertification	8/16/2021 7:47:49 AM	9/5/2022 4:29:34 PM	9/5/2022 4:29 PM
Contacts	Authorizing Official	Update	Change Request	Ulery, Brian Chief Operating Officer Thomas Memorial Hospital 3047663445	Skeldon, Timothy Chief Financial Officer Thomas Health 3047663428	6/9/2022 8:25 AM
Details	Last Recertification Date	Update	Recertification	9/10/2020 9:50:00 AM	8/16/2021 7:47:49 AM	8/16/2021 7:47 AM
Details	Last Recertification Date	Update	Recertification	8/27/2019 7:45:22 PM	9/10/2020 9:50:00 AM	9/10/2020 9:50 AM
Details	Entity Subname	Update	Recertification	TMH Neurodiagnostic Center - Neurology	Thomas Health Neurology on Division Street Department of Thomas Memorial Hospital	9/10/2020 9:50 AM
Contacts	Authorizing Official	Update	Change Request	Ulery, Brian L Chief Operating Officer (COO) Thomas Health 3047663445	Ulery, Brian Chief Operating Officer Thomas Memorial Hospital 3047663445	4/23/2020 2:29 PM
Details	Last Recertification Date	Update	Recertification	8/20/2018 8:24:21 AM	8/27/2019 7:45:22 PM	8/27/2019 7:45 PM
Details	Last Recertification Date	Update	Recertification		8/20/2018 8:24:21 AM	8/20/2018 8:24 AM
Details	State	Update		Approved	Active	4/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Ulery, Brian L Chief Operating Officer (COO) Thomas Health 3047663445	1/30/2018 3:32 PM
Details	340B ID	Update	New Registration		DSH510029AA	1/30/2018 3:32 PM
Details	Entity Subname	Update	New Registration	TMH Neurodiagnostic Center	TMH Neurodiagnostic Center - Neurology	1/30/2018 3:32 PM
Dates	Participating Approval Date	Update	New Registration		1/30/2018 3:32:47 PM	1/30/2018 3:32 PM
Details	State	Update	New Registration	Pending	Approved	1/30/2018 3:32 PM
Dates	Signed By Date	Update	New Registration		1/12/2018 1:28:02 PM	1/30/2018 3:32 PM
Dates	Start Date	Update	New Registration		4/1/2018 12:00:00 AM	1/30/2018 3:32 PM
Addresses	Main Address	Insert	New Registration		424 Division Street South Charleston, WV 25309	1/12/2018 11:04 AM
Addresses	Billing Address	Insert	New Registration		Thomas Memorial Hospital 4605 MacCorkle Avenue, SW South Charleston, WV 25309	1/12/2018 11:04 AM
Addresses	Shipping Address	Insert	New Registration		Thomas Memorial Hospital 4605 MacCorkle Avenue, SW South Charleston, WV 25309	1/12/2018 11:04 AM
Contacts	Primary Contact	Insert	New Registration		Priddy, Ken 340B Program Director Thomas Memorial Hospital 3047664320	1/12/2018 11:04 AM
Contacts	Authorizing Official	Insert	New Registration		Ulery, Brian L Chief Operating Officer (COO) Thomas Health 3047663445	1/12/2018 11:04 AM
Details	Last Recertification Date	Insert	New Registration			1/12/2018 11:04 AM
Details	Grant Number	Insert	New Registration			1/12/2018 11:04 AM
Details	340B ID	Insert	New Registration			1/12/2018 11:04 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/12/2018 11:04 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/12/2018 11:04 AM
Details	Medicare Provider Number	Insert	New Registration		510029	1/12/2018 11:04 AM
Details	Entity Name	Insert	New Registration		Thomas Memorial Hospital	1/12/2018 11:04 AM
Details	Program Code	Insert	New Registration		DSH	1/12/2018 11:04 AM
Details	Entity Subname	Insert	New Registration		TMH Neurodiagnostic Center	1/12/2018 11:04 AM
Dates	Participating Approval Date	Insert	New Registration			1/12/2018 11:04 AM
Details	State	Insert	New Registration		Pending	1/12/2018 11:04 AM
Dates	Registration Date	Insert	New Registration		1/12/2018 11:04:55 AM	1/12/2018 11:04 AM
Dates	Signed By Date	Insert	New Registration			1/12/2018 11:04 AM
Dates	Start Date	Insert	New Registration			1/12/2018 11:04 AM
Terminations	Termination Comments	Insert	New Registration			1/12/2018 11:04 AM
Terminations	Termination Date	Insert	New Registration			1/12/2018 11:04 AM
Terminations	Termination Effective Date	Insert	New Registration			1/12/2018 11:04 AM
Terminations	Termination Reason	Insert	New Registration			1/12/2018 11:04 AM