Covered Entity Details

DSH510086 WELCH COMMUNITY HOSPITAL (Active) - information as of 4/23/2025 10:54:09 PM

Main Details

Name

WELCH COMMUNITY HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH510086

Medicare Provider Number

510086

Additional Details

Current Program Status

Active

Registration Date

10/1/2024

Participating Start Date

1/1/2025

Participating Approval Date

10/30/2024

Last Recertification Date

Contacts

Authorizing Official

WELCH COMMUNITY HOSPITAL
HAZEL ARLENE ADDAIR, CHIEF FINANCIAL OFFICER
(304) 436-8683

Primary Contact

Welch Community Hospital
Katherine Belcher, Assistant
(304) 922-0534

Addresses

Street Address

454 MCDOWELL STREET
WELCH, WV 24801

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participating from effective date: (01/01/2022) until terminated effective date: (10/01/2023); reinstatement effective date: (01/1/2025)	10/03/2024
Participated starting 1/1/2020; Terminated 10/1/2021; Reinstated 1/1/2022	11/30/2021
Participated starting 1/1/202; Terminated 10/1/2021; Reinstated 1/1/2022.	10/12/2021

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	BLACK DIAMOND PHARMACY	33800 COAL HERITAGE ROAD	PO BOX 397	NORTHFORK	WV	24868	01/14/2020	04/01/2020	10/01/2021	10/01/2021
Contract Detail	FLAT IRON PHARMACY, LLC	O/A FLAT IRON DRUG STORE	69 MCDOWELL ST FLAT IRON PHARMACY	WELCH	WV	24801-2480	01/14/2020	04/01/2020	10/01/2021	10/01/2021
Contract Detail	WELCH PHARMACY, INC	D/B/A CITIZENS DRUG STORE	70 WYOMING ST D B A CITIZENS DRUG STORE	WELCH	WV	24801	01/14/2020	04/01/2020	10/01/2021	10/01/2021

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
No records to display.

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	1/1/2025 12:01 AM
Contacts	Primary Contact	Update	Reinstatement	Calhoun, Sherry Accounting Tech IV WELCH COMMUNITY HOSPITAL 3044368684	Belcher, Katherine Assistant Welch Community Hospital 3049220534	10/30/2024 8:36 AM
Details	Last Recertification Date	Update	Reinstatement	9/15/2022 1:08:57 PM		10/30/2024 8:36 AM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	9/30/2023 12:00:00 AM		10/30/2024 8:36 AM
Dates	Participating Approval Date	Update	Reinstatement	12/7/2021 12:10:58 PM	10/30/2024 8:36:23 AM	10/30/2024 8:36 AM
Details	State	Update	Reinstatement	Terminated	Approved	10/30/2024 8:36 AM
Dates	Registration Date	Update	Reinstatement	10/7/2021 11:23:21 AM	10/1/2024 1:53:24 PM	10/30/2024 8:36 AM
Dates	Signed By Date	Update	Reinstatement	10/7/2021 11:23:24 AM	10/22/2024 10:29:48 AM	10/30/2024 8:36 AM
Dates	Start Date	Update	Reinstatement	1/1/2022 12:00:00 AM	1/1/2025 12:00:00 AM	10/30/2024 8:36 AM
Terminations	Termination Date	Update	Reinstatement	10/1/2023 12:00:00 AM		10/30/2024 8:36 AM
Terminations	Termination Effective Date	Update	Reinstatement	10/1/2023 12:00:00 AM		10/30/2024 8:36 AM
Terminations	Termination Reason	Update	Reinstatement	Failure to recertify		10/30/2024 8:36 AM
Details	Comments Public	Insert	Reinstatement		Participating from effective date: (01/01/2022) until terminated effective date: (10/01/2023); reinstatement effective date: (01/1/2025)	10/3/2024 7:04 AM
Contacts	Authorizing Official	Update	Profile Change Request	ADDAIR, HAZEL ARLENE PROCUREMENT SUPERVISOR WELCH COMMUNITY HOSPITAL 3044368683	ADDAIR, HAZEL ARLENE CHIEF FINANCIAL OFFICER WELCH COMMUNITY HOSPITAL 3044368683	9/20/2024 11:15 AM
Contacts	Signed By	Update	Profile Change Request	ADDAIR, HAZEL ARLENE PROCUREMENT SUPERVISOR WELCH COMMUNITY HOSPITAL 3044368683	ADDAIR, HAZEL ARLENE CHIEF FINANCIAL OFFICER WELCH COMMUNITY HOSPITAL 3044368683	9/20/2024 11:15 AM
Contacts	Authorizing Official	Update	Profile Change Request	ADDAIR, HAZEL ARLENE PROCUREMENT SUPERVISOR WELCH COMMUNITY HOSPITAL 3044368742	ADDAIR, HAZEL ARLENE PROCUREMENT SUPERVISOR WELCH COMMUNITY HOSPITAL 3044368683	8/26/2024 11:24 AM
Contacts	Signed By	Update	Profile Change Request	ADDAIR, HAZEL ARLENE PROCUREMENT SUPERVISOR WELCH COMMUNITY HOSPITAL 3044368742	ADDAIR, HAZEL ARLENE PROCUREMENT SUPERVISOR WELCH COMMUNITY HOSPITAL 3044368683	8/26/2024 11:24 AM
Details	State	Update		To Be Terminated	Terminated	10/1/2023 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		9/30/2023 12:00:00 AM	9/18/2023 3:54 PM
Details	State	Update	Recertification	Active	To Be Terminated	9/18/2023 3:54 PM
Terminations	Termination Date	Update	Recertification		10/1/2023 12:00:00 AM	9/18/2023 3:54 PM
Terminations	Termination Effective Date	Update	Recertification		10/1/2023 12:00:00 AM	9/18/2023 3:54 PM
Terminations	Termination Reason	Update	Recertification		Failure to recertify	9/18/2023 3:54 PM
Details	Last Recertification Date	Update	Recertification		9/15/2022 1:08:57 PM	9/15/2022 1:08 PM
Details	State	Update		Approved	Active	1/1/2022 12:01 AM
Contacts	Signed By	Update	Reinstatement	Brant, Johnny R CFO Welch Community Hospital 3044368461	ADDAIR, HAZEL ARLENE PROCUREMENT SUPERVISOR WELCH COMMUNITY HOSPITAL 3044368742	12/7/2021 12:10 PM
Contacts	Primary Contact	Update	Reinstatement	Mitchem, Cheryl Director Tug River Health Association 3049383182	Calhoun, Sherry Accounting Tech IV WELCH COMMUNITY HOSPITAL 3044368684	12/7/2021 12:10 PM
Details	Last Recertification Date	Update	Reinstatement	8/26/2020 9:32:04 AM		12/7/2021 12:10 PM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	9/30/2021 12:00:00 AM		12/7/2021 12:10 PM
Dates	Participating Approval Date	Update	Reinstatement	11/24/2019 7:47:59 PM	12/7/2021 12:10:58 PM	12/7/2021 12:10 PM
Details	State	Update	Reinstatement	Terminated	Approved	12/7/2021 12:10 PM
Dates	Registration Date	Update	Reinstatement	10/9/2019 12:21:54 PM	10/7/2021 11:23:21 AM	12/7/2021 12:10 PM
Dates	Signed By Date	Update	Reinstatement	10/23/2019 11:29:41 AM	10/7/2021 11:23:24 AM	12/7/2021 12:10 PM
Dates	Start Date	Update	Reinstatement	1/1/2020 12:00:00 AM	1/1/2022 12:00:00 AM	12/7/2021 12:10 PM
Terminations	Termination Date	Update	Reinstatement	10/1/2021 12:00:00 AM		12/7/2021 12:10 PM
Terminations	Termination Effective Date	Update	Reinstatement	10/1/2021 12:00:00 AM		12/7/2021 12:10 PM
Terminations	Termination Reason	Update	Reinstatement	Failure to recertify		12/7/2021 12:10 PM
Details	Comments Public	Insert	Reinstatement		Participated starting 1/1/2020; Terminated 10/1/2021; Reinstated 1/1/2022	11/30/2021 4:06 PM
Details	Comments Public	Insert	Reinstatement		Participated starting 1/1/202; Terminated 10/1/2021; Reinstated 1/1/2022.	10/12/2021 11:42 AM
Details	State	Update		To Be Terminated	Terminated	10/1/2021 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		9/30/2021 12:00:00 AM	9/21/2021 9:20 AM
Details	State	Update	Recertification	Active	To Be Terminated	9/21/2021 9:20 AM
Terminations	Termination Date	Update	Recertification		10/1/2021 12:00:00 AM	9/21/2021 9:20 AM
Terminations	Termination Effective Date	Update	Recertification		10/1/2021 12:00:00 AM	9/21/2021 9:20 AM
Terminations	Termination Reason	Update	Recertification		Failure to recertify	9/21/2021 9:20 AM
Contacts	Authorizing Official	Update	Change Request	Brant, Johnny R CFO Welch Community Hospital 3044368461	ADDAIR, HAZEL ARLENE PROCUREMENT SUPERVISOR WELCH COMMUNITY HOSPITAL 3044368742	4/8/2021 1:31 PM
Details	Last Recertification Date	Update	Recertification		8/26/2020 9:32:04 AM	8/26/2020 9:32 AM
Details	State	Update		Approved	Active	1/1/2020 12:04 AM
Contacts	Signed By	Insert	New Registration		Brant, Johnny R CFO Welch Community Hospital 3044368461	11/24/2019 7:47 PM
Details	340B ID	Update	New Registration		DSH510086	11/24/2019 7:47 PM
Dates	Participating Approval Date	Update	New Registration		11/24/2019 7:47:59 PM	11/24/2019 7:47 PM
Details	State	Update	New Registration	Pending	Approved	11/24/2019 7:47 PM
Dates	Signed By Date	Update	New Registration		10/23/2019 11:29:41 AM	11/24/2019 7:47 PM
Dates	Start Date	Update	New Registration		1/1/2020 12:00:00 AM	11/24/2019 7:47 PM
Addresses	Main Address	Insert	New Registration		454 MCDOWELL STREET WELCH, WV 24801	10/9/2019 12:21 PM
Contacts	Primary Contact	Insert	New Registration		Mitchem, Cheryl Director Tug River Health Association 3049383182	10/9/2019 12:21 PM
Contacts	Authorizing Official	Insert	New Registration		Brant, Johnny R CFO Welch Community Hospital 3044368461	10/9/2019 12:21 PM
Details	Last Recertification Date	Insert	New Registration			10/9/2019 12:21 PM
Details	Grant Number	Insert	New Registration			10/9/2019 12:21 PM
Details	340B ID	Insert	New Registration			10/9/2019 12:21 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/9/2019 12:21 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/9/2019 12:21 PM
Details	Medicare Provider Number	Insert	New Registration		510086	10/9/2019 12:21 PM
Details	Entity Name	Insert	New Registration		WELCH COMMUNITY HOSPITAL	10/9/2019 12:21 PM
Details	Program Code	Insert	New Registration		DSH	10/9/2019 12:21 PM
Details	Entity Subname	Insert	New Registration			10/9/2019 12:21 PM
Dates	Participating Approval Date	Insert	New Registration			10/9/2019 12:21 PM
Details	State	Insert	New Registration		Pending	10/9/2019 12:21 PM
Dates	Registration Date	Insert	New Registration		10/9/2019 12:21:54 PM	10/9/2019 12:21 PM
Dates	Signed By Date	Insert	New Registration			10/9/2019 12:21 PM
Dates	Start Date	Insert	New Registration			10/9/2019 12:21 PM
Terminations	Termination Comments	Insert	New Registration			10/9/2019 12:21 PM
Terminations	Termination Date	Insert	New Registration			10/9/2019 12:21 PM
Terminations	Termination Effective Date	Insert	New Registration			10/9/2019 12:21 PM
Terminations	Termination Reason	Insert	New Registration			10/9/2019 12:21 PM