Covered Entity Details

DSH510006T UNITED HOSPITAL CENTER (Active) - information as of 6/25/2025 12:48:59 AM

Main Details

Name

UNITED HOSPITAL CENTER

Subdivision Name

UHC Thoracic Surgery - Thoracic Surgery

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH510006T

Medicare Provider Number

510006

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/15/2019

Participating Start Date

1/1/2020

Participating Approval Date

10/25/2019

Last Recertification Date

8/16/2024

Contacts

Authorizing Official

United Hospital Center
James Rutkowski, VP Finance/CFO
(681) 342-1605

Primary Contact

United Hospital Center
Carlton K. Hoskinson Jr., Director
(681) 342-1560

Addresses

Street Address

527 Medical Park Drive
Suite 108
Bridgeport, WV 26330

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
VA		1184606600
WV		1184606600
OH		1184606600
PA		1184606600
KY		1184606600

Shipping Addresses

Shipping Address 1

West Virginia United Health System Inc DBA Enterprise Pharmacy Solutions
781 Chestnut Ridge Rd
Suite 600
Morgantown, WV 26505-0015

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
DSH510006A	Child	DSH	UNITED HOSPITAL CENTER	FAMILY PRACTICE	527 MEDICAL PARK DR	BRIDGEPORT	WV	Active
DSH510006B	Child	DSH	UNITED HOSPITAL CENTER	Wound Care Clinic	916W MAIN ST	BRIDGEPORT	WV	Active
DSH510006C	Child	DSH	UNITED HOSPITAL CENTER	UNITED HOSPITAL CENTER INC - UHC GASTROENTEROLGOY	527 MEDICAL PARK DR	BRIDGEPORT	WV	Active
DSH510006D	Child	DSH	UNITED HOSPITAL CENTER	UNITED HOSPITAL CENTER - UHC RHEUMATOLOGY	120 Medical Park Drive	BRIDGEPORT	WV	Active
DSH510006E	Child	DSH	UNITED HOSPITAL CENTER	UNITED HOSPITAL CENTER INC - GENERAL SURGERY	527 MEDICAL PARK DR	BRIDGEPORT	WV	Active
DSH510006F	Child	DSH	UNITED HOSPITAL CENTER	UNITED HOSPITAL CENTER INC - PLASTIC SURGERY	527 MEDICAL PARK DR	BRIDGEPORT	WV	Active
DSH510006G	Child	DSH	UNITED HOSPITAL CENTER	UNITED HOSPITAL CENTER INC - UHC ENT & AUDIOLOGY	527 MEDICAL PARK DR	BRIDGEPORT	WV	Active
DSH510006H	Child	DSH	UNITED HOSPITAL CENTER	UNITED HOSPITAL CENTER INC - UHC ORTHOPAEDICS	227 MEDICAL PARK DR	BRIDGEPORT	WV	Active
DSH510006J	Child	DSH	UNITED HOSPITAL CENTER	UNITED HOSPITAL CENTER INC - ONCOLOGY	327 MEDICAL PARK DR	BRIDGEPORT	WV	Active
DSH510006K	Child	DSH	UNITED HOSPITAL CENTER	UNITED HOSPITAL CENTER INC - UROLOGY	135 PROFESSIONAL PL	BRIDGEPORT	WV	Active
DSH510006L	Child	DSH	UNITED HOSPITAL CENTER	Weston Infusion Center - Infusion Center	107 Staunton Drive	Weston	WV	Active
DSH510006M	Child	DSH	UNITED HOSPITAL CENTER	UHC Pulmonology - Pulmonology	527 Medical Park Drive	Bridgeport	WV	Active
DSH510006N	Child	DSH	UNITED HOSPITAL CENTER	UHC Ophthalmology - Ophthalmology	1370 Johnson Avenue	Bridgeport	WV	Active
DSH510006P	Child	DSH	UNITED HOSPITAL CENTER	UHC Nephrology - Nephrology	527 Medical Park Drive	Bridgeport	WV	Active
DSH510006Q	Child	DSH	UNITED HOSPITAL CENTER	UHC Cardiology - Cardiology	527 Medical Park Drive	Bridgeport	WV	Active
DSH510006R	Child	DSH	UNITED HOSPITAL CENTER	UHC Infectious Disease - Infectious Disease	527 Medical Park Drive	Bridgeport	WV	Active
DSH510006S	Child	DSH	UNITED HOSPITAL CENTER	UHC Specialty Clinic in Weston - Multi-specialty clinic	107 Staunton Drive	Weston	WV	Terminated
DSH510006T	Child	DSH	UNITED HOSPITAL CENTER	UHC Thoracic Surgery - Thoracic Surgery	527 Medical Park Drive	Bridgeport	WV	Active
DSH510006U	Child	DSH	UNITED HOSPITAL CENTER	UHC Internal Medicine - Internal Medicine	527 Medical Park Drive	Bridgeport	WV	Active
DSH510006V	Child	DSH	UNITED HOSPITAL CENTER	Pain clinic; Neuro pain management clinic - pain clinic	107 Staunton Drive	Weston	WV	Active
DSH510006W	Child	DSH	UNITED HOSPITAL CENTER	90.01 - Medical Weight Loss Management	527 Medical Park Drive	Bridgeport	WV	Active
DSH510006X	Child	DSH	UNITED HOSPITAL CENTER	Nephrology - Nephrology	107 Staunton Drive	Weston	WV	Active
DSH510006Y	Child	DSH	UNITED HOSPITAL CENTER	Podiatry - Podiatry	527 Medical Park Drive	Bridgeport	WV	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Main Address	Update	Change Request	527 Medical Park Drive Suite 205 Bridgeport, WV 26330	527 Medical Park Drive Suite 108 Bridgeport, WV 26330	10/30/2024 11:01 AM
Addresses	Shipping Address	Insert	Group Change Request		West Virginia United Health System Inc DBA Enterprise Pharmacy Solutions 781 Chestnut Ridge Rd Suite 600 Morgantown, WV 26505-0015	10/16/2024 2:57 PM
Details	Last Recertification Date	Update	Recertification	8/18/2023 3:27:36 PM	8/16/2024 2:30:39 PM	8/16/2024 2:30 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1276000 (WV)		6/3/2024 12:33 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1184606600 (VA)		6/3/2024 12:33 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	421069700 (MD)		6/3/2024 12:33 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1184606600 (MD)		6/3/2024 12:33 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1184606600	6/3/2024 12:33 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	6/3/2024 12:33 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1184606600	6/3/2024 12:33 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	6/3/2024 12:33 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1184606600	6/3/2024 12:33 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	6/3/2024 12:33 PM
Details	Last Recertification Date	Update	Recertification	9/13/2022 2:53:59 PM	8/18/2023 3:27:36 PM	8/18/2023 3:27 PM
Details	Last Recertification Date	Update	Recertification	9/8/2021 4:29:01 PM	9/13/2022 2:53:59 PM	9/13/2022 2:53 PM
Details	Last Recertification Date	Update	Recertification	9/4/2020 12:27:11 PM	9/8/2021 4:29:01 PM	9/8/2021 4:29 PM
Addresses	Main Address	Update	Change Request	527 Medical Park Drive Suite 306 Bridgeport, WV 26330	527 Medical Park Drive Suite 205 Bridgeport, WV 26330	3/4/2021 8:09 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1598097735 (WV)		9/10/2020 5:35 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1598097735 (VA)		9/10/2020 5:35 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1598097735 (MD)		9/10/2020 5:35 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1184606600	9/10/2020 5:35 PM
Medicaid Billing	NPI: State	Insert	Change Request		VA	9/10/2020 5:35 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1184606600	9/10/2020 5:35 PM
Medicaid Billing	NPI: State	Insert	Change Request		WV	9/10/2020 5:35 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1184606600	9/10/2020 5:35 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	9/10/2020 5:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/4/2020 12:27 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1276000	9/4/2020 12:27 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WV	9/4/2020 12:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/4/2020 12:27 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1184606600	9/4/2020 12:27 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/4/2020 12:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/4/2020 12:27 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		421069700	9/4/2020 12:27 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/4/2020 12:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1598097735	9/4/2020 12:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/4/2020 12:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1598097735	9/4/2020 12:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/4/2020 12:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1598097735	9/4/2020 12:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/4/2020 12:27 PM
Details	Last Recertification Date	Update	Recertification		9/4/2020 12:27:11 PM	9/4/2020 12:27 PM
Details	State	Update		Approved	Active	1/1/2020 12:04 AM
Contacts	Signed By	Insert	New Registration		Rutkowski, James VP Finance/CFO United Hospital Center 6813421605	10/25/2019 7:39 AM
Details	340B ID	Update	New Registration		DSH510006T	10/25/2019 7:39 AM
Details	Entity Subname	Update	New Registration	UHC Thoracic Surgery	UHC Thoracic Surgery - Thoracic Surgery	10/25/2019 7:39 AM
Dates	Participating Approval Date	Update	New Registration		10/25/2019 7:39:23 AM	10/25/2019 7:39 AM
Details	State	Update	New Registration	Pending	Approved	10/25/2019 7:39 AM
Dates	Signed By Date	Update	New Registration		10/15/2019 6:13:29 PM	10/25/2019 7:39 AM
Dates	Start Date	Update	New Registration		1/1/2020 12:00:00 AM	10/25/2019 7:39 AM
Addresses	Main Address	Insert	New Registration		527 Medical Park Drive Suite 306 Bridgeport, WV 26330	10/15/2019 6:13 PM
Contacts	Authorizing Official	Insert	New Registration		Rutkowski, James VP Finance/CFO United Hospital Center 6813421605	10/15/2019 6:13 PM
Contacts	Primary Contact	Insert	New Registration		Hoskinson Jr., Carlton K. Director United Hospital Center 6813421560	10/15/2019 6:13 PM
Details	Last Recertification Date	Insert	New Registration			10/15/2019 6:13 PM
Details	Grant Number	Insert	New Registration			10/15/2019 6:13 PM
Details	340B ID	Insert	New Registration			10/15/2019 6:13 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/15/2019 6:13 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/15/2019 6:13 PM
Details	Medicare Provider Number	Insert	New Registration		510006	10/15/2019 6:13 PM
Details	Entity Name	Insert	New Registration		UNITED HOSPITAL CENTER	10/15/2019 6:13 PM
Details	Program Code	Insert	New Registration		DSH	10/15/2019 6:13 PM
Details	Entity Subname	Insert	New Registration		UHC Thoracic Surgery	10/15/2019 6:13 PM
Dates	Participating Approval Date	Insert	New Registration			10/15/2019 6:13 PM
Details	State	Insert	New Registration		Pending	10/15/2019 6:13 PM
Dates	Registration Date	Insert	New Registration		10/15/2019 6:13:26 PM	10/15/2019 6:13 PM
Dates	Signed By Date	Insert	New Registration			10/15/2019 6:13 PM
Dates	Start Date	Insert	New Registration			10/15/2019 6:13 PM
Terminations	Termination Comments	Insert	New Registration			10/15/2019 6:13 PM
Terminations	Termination Date	Insert	New Registration			10/15/2019 6:13 PM
Terminations	Termination Effective Date	Insert	New Registration			10/15/2019 6:13 PM
Terminations	Termination Reason	Insert	New Registration			10/15/2019 6:13 PM