Covered Entity Details

CH03405C BLUE RIDGE MEDICAL CENTER INC (Active) - information as of 5/15/2025 11:41:32 PM

Main Details

Name

BLUE RIDGE MEDICAL CENTER INC

Subdivision Name

Blue Ridge Medical Center--Amherst

Type

HRSA-Funded Health Center

Site ID

BPS-H80-025003

340B ID

CH03405C

Grant Number

H80CS00175

Additional Details

Current Program Status

Active

Registration Date

4/3/2019

Participating Start Date

7/1/2019

Participating Approval Date

4/3/2019

Last Recertification Date

2/17/2025

Contacts

Authorizing Official

Blue Ridge Medical Center
Rodney S Johnson, CEO
(434) 263-4000

Primary Contact

Blue Ridge Medical Center
Kathy Bryant, Pharmacy Director
(434) 263-4810

Addresses

Street Address

210 S Main St
Amherst, VA 24521-2616

Billing Address

Blue RIdge Medical Center
4038 Thomas Nelson Highway
Arrington, VA 22922

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
VA	8510865	1083675862

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
Contract Detail	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07002	112 S. MAIN ST. / P.O. BOX 1017	AMHERST	VA	24521	07/12/2023	10/01/2023			10/01/2023

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH034050	Active	BPS-H80-003231	BLUE RIDGE MEDICAL CENTER INC	BLUE RIDGE MEDICAL CENTER, INC.	4038 Thomas Nelson Hwy	Arrington	VA
CH03405A	Terminated	BPS-H80-020913	BLUE RIDGE MEDICAL CENTER INC	Amherst Wellness Center	120 W. Commerce Street	Amherst	VA
CH03405B	Terminated	BPS-H80-018855	BLUE RIDGE MEDICAL CENTER INC	Nelson Counseling Center, Region Ten Community Services Board	71 Tanbark Plaza	Lovingston	VA
CH03405C	Active	BPS-H80-025003	BLUE RIDGE MEDICAL CENTER INC	Blue Ridge Medical Center--Amherst	210 S Main St	Amherst	VA
CH03405D	Active	BPS-H80-027619	BLUE RIDGE MEDICAL CENTER INC	Blue Ridge Dental Center	4038 Thomas Nelson Hwy STE B	Arrington	VA
CH03405E	Active	BPS-H80-033525	BLUE RIDGE MEDICAL CENTER INC	Blue Ridge Medical Center Appomattox	624 Jones Street	Appomattox	VA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH034050	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2023
CH034050	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2023
CH034050	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2023
CH034050	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2023
CH034050	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2023
CH034050	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/01/2023
CH034050	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/01/2023
CH034050	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	04/01/2025
CH034050	AVELLA OF COLUMBUS	4830 KNIGHTSBRIDGE BLVD STE C		COLUMBUS	OH	43214-2300	01/01/2019	01/20/2022
CH034050	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	01/01/2019	01/20/2022
CH034050	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019	10/02/2020
CH034050	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	01/01/2023	01/15/2025
CH034050	CENTERWELL PHARMACY, INC.	9843 WINDISCH RD		WEST CHESTER	OH	45069	04/01/2023
CH034050	CENTERWELL PHARMACY, INC.	11010 FLORIDA CROWN DRIVE, SUITE 200		ORLANDO	FL	32824	07/01/2024
CH034050	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2022
CH034050	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2022
CH034050	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	07/01/2018	01/11/2019
CH034050	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/01/2023
CH034050	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/01/2023
CH034050	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/01/2023
CH034050	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/01/2023
CH034050	HOMETOWN PHARMACY	199 OLD COURTHOUSE RD		APPOMATTOX	VA	24522	07/01/2024
CH034050	HOMETOWN PHARMACY	196 AMELON SQ		MADISON HEIGHTS	VA	24572-5990	07/01/2024
CH034050	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	07/01/2018	01/11/2019
CH034050	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	07/01/2018
CH034050	PILLPACK LLC	AMAZON PHARMACY #005	20416 72ND AVE S	KENT	WA	98032-2319	04/01/2025
CH034050	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07002	112 S. MAIN ST. / P.O. BOX 1017	AMHERST	VA	24521	04/01/2019
CH034050	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03502	3908 CAMPBELL AVE	LYNCHBURG	VA	24501	01/01/2021
CH034050	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03515	7738 RICHMOND HIGHWAY	APPOMATTOX	VA	24522	01/01/2021
CH034050	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03512	2259 LANGHORNE ROAD	LYNCHBURG	VA	24501	01/01/2021
CH034050	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04285	21550 TIMBERLAKE RD.	LYNCHBURG	VA	24502	01/01/2021
CH034050	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03509	4861 AMHERST HWY, PO BOX 570	MADISON HEIGHTS	VA	24572	01/01/2021
CH034050	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07363	3100 OLD FOREST ROAD	LYNCHBURG	VA	24501	01/01/2021	10/31/2023
CH034050	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07948	14566 FOREST RD.	FOREST	VA	24551	01/01/2021	03/21/2022
CH034050	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01559	919 SOUTH MAIN ST	FARMVILLE	VA	23901	01/01/2021
CH034050	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01555	1133 5TH STREET SW	CHARLOTTESVILLE	VA	22902	01/01/2021	03/21/2022
CH034050	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03548	2009 WARDS ROAD	LYNCHBURG	VA	24502	01/01/2021
CH034050	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07028	18665 FOREST ROAD	LYNCHBURG	VA	24502	07/01/2022
CH034050	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00074	2823 W. MAIN ST.	WAYNESBORO	VA	22980	07/01/2022
CH034050	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05514	2148 EAST MIDLAND TRAIL	BUENA VISTA	VA	24416	07/01/2022
CH03405C	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07002	112 S. MAIN ST. / P.O. BOX 1017	AMHERST	VA	24521	10/01/2023
CH03405E	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03515	7738 RICHMOND HIGHWAY	APPOMATTOX	VA	24522	10/01/2023
CH034050	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2020
CH034050	WAL-MART PHARMACY 10-2565	197 MADISON HEIGHTS SQUARE		MADISON HEIGHTS	VA	24572	01/01/2019
CH034050	WAL-MART PHARMACY 10-4636	505 OAKVILLE ROAD		APPOMATTOX	VA	24522	01/01/2019
CH034050	WAL-MART PHARMACY 10-4697	3227 OLD FOREST ROAD		LYNCHBURG	VA	24501	01/01/2019	03/24/2023
CH034050	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2020
CH034050	WALGREEN CO.	WALGREENS #17477	74 TANBARK PLZ P.O. BOX 318	LOVINGSTON	VA	22949-2464	10/01/2020	03/01/2023
CH034050	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH034050	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	07/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/30/2024 12:39:58 PM	2/17/2025 11:11:44 AM	2/17/2025 11:11 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/25/2024 10:14 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		8510865	10/25/2024 10:14 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		VA	10/25/2024 10:14 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1083675862	10/25/2024 10:14 AM
Medicaid Billing	NPI: State	Insert	Change Request		VA	10/25/2024 10:14 AM
Details	Last Recertification Date	Update	Recertification	2/7/2023 4:47:56 PM	1/30/2024 12:39:58 PM	1/30/2024 12:39 PM
Contacts	Authorizing Official	Update	Group Change Request	Belcher, Lloyd Allan CEO Blue Ridge Medical Center 4342634000	Johnson, Rodney S CEO Blue Ridge Medical Center 4342634000	9/25/2023 4:29 PM
Details	Last Recertification Date	Update	Recertification	2/2/2022 11:13:58 AM	2/7/2023 4:47:56 PM	2/7/2023 4:47 PM
Contacts	Authorizing Official	Update	AO Change Request	Shinn, Rick CEO Blue Ridge Medical Center 4342634000-1322	Belcher, Lloyd Allan CEO Blue Ridge Medical Center 4342634000	2/3/2023 1:39 PM
Contacts	Authorizing Official	Update	Profile Change Request	Shinn, Rick Interim CEO Blue Ridge Medical Center 4342634000	Shinn, Rick CEO Blue Ridge Medical Center 4342634000-1322	4/14/2022 9:37 AM
Details	Last Recertification Date	Update	Recertification	2/4/2021 9:27:55 AM	2/2/2022 11:13:58 AM	2/2/2022 11:13 AM
Contacts	Authorizing Official	Update	Group Change Request	Pirtle, Randolph CEO Blue Ridge Medical Center 4342634000	Shinn, Rick Interim CEO Blue Ridge Medical Center 4342634000	11/1/2021 9:25 AM
Details	Last Recertification Date	Update	Recertification	1/27/2020 10:14:43 AM	2/4/2021 9:27:55 AM	2/4/2021 9:27 AM
Addresses	Shipping Address	Delete	Change Request	Blue Ridge Medical Center 4038 Thomas Nelson Highway Arrington, VA 22922		9/17/2020 1:52 PM
Details	Last Recertification Date	Update	Recertification		1/27/2020 10:14:43 AM	1/27/2020 10:14 AM
Details	State	Update		Approved	Active	7/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Pirtle, Randolph CEO Blue Ridge Medical Center 4342634000	4/3/2019 3:19 PM
Details	340B ID	Update	New Registration		CH03405C	4/3/2019 3:19 PM
Dates	Participating Approval Date	Update	New Registration		4/3/2019 3:19:27 PM	4/3/2019 3:19 PM
Details	State	Update	New Registration	Pending	Approved	4/3/2019 3:19 PM
Dates	Signed By Date	Update	New Registration		4/3/2019 1:04:05 PM	4/3/2019 3:19 PM
Dates	Start Date	Update	New Registration		7/1/2019 12:00:00 AM	4/3/2019 3:19 PM
Addresses	Main Address	Insert	New Registration		210 S Main St Amherst, VA 24521-2616	4/3/2019 12:34 PM
Addresses	Billing Address	Insert	New Registration		Blue RIdge Medical Center 4038 Thomas Nelson Highway Arrington, VA 22922	4/3/2019 12:34 PM
Addresses	Shipping Address	Insert	New Registration		Blue Ridge Medical Center 4038 Thomas Nelson Highway Arrington, VA 22922	4/3/2019 12:34 PM
Contacts	Primary Contact	Insert	New Registration		Bryant, Kathy Pharmacy Director Blue Ridge Medical Center 4342634810	4/3/2019 12:34 PM
Contacts	Authorizing Official	Insert	New Registration		Pirtle, Randolph CEO Blue Ridge Medical Center 4342634000	4/3/2019 12:34 PM
Details	Last Recertification Date	Insert	New Registration			4/3/2019 12:34 PM
Details	Grant Number	Insert	New Registration		H80CS00175	4/3/2019 12:34 PM
Details	340B ID	Insert	New Registration			4/3/2019 12:34 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/3/2019 12:34 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/3/2019 12:34 PM
Details	Medicare Provider Number	Insert	New Registration			4/3/2019 12:34 PM
Details	Entity Name	Insert	New Registration		BLUE RIDGE MEDICAL CENTER INC	4/3/2019 12:34 PM
Details	Program Code	Insert	New Registration		CH	4/3/2019 12:34 PM
Details	Entity Subname	Insert	New Registration		Blue Ridge Medical Center--Amherst	4/3/2019 12:34 PM
Dates	Participating Approval Date	Insert	New Registration			4/3/2019 12:34 PM
Details	State	Insert	New Registration		Pending	4/3/2019 12:34 PM
Dates	Registration Date	Insert	New Registration		4/3/2019 12:34:58 PM	4/3/2019 12:34 PM
Dates	Signed By Date	Insert	New Registration			4/3/2019 12:34 PM
Dates	Start Date	Insert	New Registration			4/3/2019 12:34 PM
Terminations	Termination Comments	Insert	New Registration			4/3/2019 12:34 PM
Terminations	Termination Date	Insert	New Registration			4/3/2019 12:34 PM
Terminations	Termination Effective Date	Insert	New Registration			4/3/2019 12:34 PM
Terminations	Termination Reason	Insert	New Registration			4/3/2019 12:34 PM

340B Drug Pricing Program Database