Yes
CAH341315-01 | Child | CAH | Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital | CAPE FEAR VALLEY BLADEN MEDICAL | 16 3RD ST | DUBLIN | NC | Active |
CAH341315-02 | Child | CAH | Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital | CAPE FEAR VALLEY-BLADEN MEDICAL ASS | 1106 W SEABOARD STREET | BLADENBORO | NC | Active |
CAH341315-03 | Child | CAH | Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital | CAPE FEAR VALLEY - BLADEN MEDICAL A | 300 A EAST MCKAY STREET | ELIZABETHTOWN | NC | Active |
CAH341315-04 | Child | CAH | Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital | CAPE FEAR VALLEY-BLADEN MEDICAL EXP | 107 EAST DUNHAM ST | ELIZABETHTOWN | NC | Active |
CAH341315-05 | Child | CAH | Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital | CFV BLADEN MEDICAL ASSOCIATES - Family medicine practice | 9858 WR Lathan Drive | CLARKTON | NC | Active |
CAH341315-06 | Child | CAH | Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital | CFV BLADEN MEDICAL ASSOCIATES - BMA White Lake | 273 WHITE LAKE DR | ELIZABETHTOWN | NC | Active |
CAH341315-07 | Child | CAH | Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital | CFV PRIMARY CARE-VINELAND FAMILY ME - Family Medicine | 630 S MADISON ST | WHITEVILLE | NC | Active |
Details | Last Recertification Date | Update | Recertification | 8/15/2023 9:25:16 AM | 8/16/2024 2:52:13 PM | 8/16/2024 2:52 PM |
Contacts | Authorizing Official | Update | AO Change Request | Fife, Stephen
President & CFO
Bladen Healthcare, LLC
9108625149 | Cummings, Spencer Lowell
President
Bladen County Hospital
9108625149 | 10/12/2023 11:35 AM |
Details | Last Recertification Date | Update | Recertification | 8/31/2022 3:15:05 PM | 8/15/2023 9:25:16 AM | 8/15/2023 9:25 AM |
Details | Last Recertification Date | Update | Recertification | 8/26/2021 1:32:16 PM | 8/31/2022 3:15:05 PM | 8/31/2022 3:15 PM |
Details | Last Recertification Date | Update | Recertification | | 8/26/2021 1:32:16 PM | 8/26/2021 1:32 PM |
Details | State | Update | | Approved | Active | 1/1/2021 12:01 AM |
Contacts | Signed By | Insert | New Registration | | Fife, Stephen
President & CFO
Bladen Healthcare, LLC
9108625149 | 10/14/2020 9:57 AM |
Details | 340B ID | Update | New Registration | | CAH341315-06 | 10/14/2020 9:57 AM |
Details | Entity Name | Update | New Registration | BLADEN COUNTY HOSPITAL | Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital | 10/14/2020 9:57 AM |
Details | Entity Subname | Update | New Registration | CFV BLADEN MEDICAL ASSOCIATES | CFV BLADEN MEDICAL ASSOCIATES - BMA White Lake | 10/14/2020 9:57 AM |
Dates | Participating Approval Date | Update | New Registration | | 10/14/2020 9:57:52 AM | 10/14/2020 9:57 AM |
Details | State | Update | New Registration | Pending | Approved | 10/14/2020 9:57 AM |
Dates | Signed By Date | Update | New Registration | | 10/13/2020 5:06:41 PM | 10/14/2020 9:57 AM |
Dates | Start Date | Update | New Registration | | 1/1/2021 12:00:00 AM | 10/14/2020 9:57 AM |
Contacts | Authorizing Official | Update | Profile Change Request | Fife, Stephen
Director of Finance
Bladen Healthcare, LLC
9108625149 | Fife, Stephen
President & CFO
Bladen Healthcare, LLC
9108625149 | 10/14/2020 7:59 AM |
Addresses | Main Address | Insert | New Registration | |
273 WHITE LAKE DR
ELIZABETHTOWN, NC 28337-6885 | 10/13/2020 12:57 PM |
Addresses | Billing Address | Insert | New Registration | | CFV-Bladen County Hospital
PO Box 398
Elizabethtown, NC 28337 | 10/13/2020 12:57 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 10/13/2020 12:57 PM |
Medicaid Billing | Medicaid: Number | Insert | New Registration | | 1528559671 | 10/13/2020 12:57 PM |
Medicaid Billing | Medicaid: State | Insert | New Registration | | NC | 10/13/2020 12:57 PM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1528559671 | 10/13/2020 12:57 PM |
Medicaid Billing | NPI: State | Insert | New Registration | | NC | 10/13/2020 12:57 PM |
Contacts | Primary Contact | Insert | New Registration | | Gentry, Karen
Pharmacy Director
Bladen Healthcare, LLC dba CFVHS-Bladen County Hospital
9108625157 | 10/13/2020 12:57 PM |
Contacts | Authorizing Official | Insert | New Registration | | Fife, Stephen
Director of Finance
Bladen Healthcare, LLC
9108625149 | 10/13/2020 12:57 PM |
Details | Assistance Received From Date | Insert | New Registration | | | 10/13/2020 12:57 PM |
Details | Assistance Received To Date | Insert | New Registration | | | 10/13/2020 12:57 PM |
Details | Last Recertification Date | Insert | New Registration | | | 10/13/2020 12:57 PM |
Details | Grant Number | Insert | New Registration | | | 10/13/2020 12:57 PM |
Details | 340B ID | Insert | New Registration | | | 10/13/2020 12:57 PM |
Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 10/13/2020 12:57 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 10/13/2020 12:57 PM |
Details | Medicare Provider Number | Insert | New Registration | | 341315 | 10/13/2020 12:57 PM |
Details | Entity Name | Insert | New Registration | | BLADEN COUNTY HOSPITAL | 10/13/2020 12:57 PM |
Details | NOFO Number | Insert | New Registration | | | 10/13/2020 12:57 PM |
Details | Program Code | Insert | New Registration | | CAH | 10/13/2020 12:57 PM |
Details | Entity Subname | Insert | New Registration | | CFV BLADEN MEDICAL ASSOCIATES | 10/13/2020 12:57 PM |
Dates | Participating Approval Date | Insert | New Registration | | | 10/13/2020 12:57 PM |
Details | State | Insert | New Registration | | Pending | 10/13/2020 12:57 PM |
Dates | Registration Date | Insert | New Registration | | 10/13/2020 12:57:49 PM | 10/13/2020 12:57 PM |
Dates | Signed By Date | Insert | New Registration | | | 10/13/2020 12:57 PM |
Dates | Start Date | Insert | New Registration | | | 10/13/2020 12:57 PM |
Terminations | Termination Comments | Insert | New Registration | | | 10/13/2020 12:57 PM |
Terminations | Termination Date | Insert | New Registration | | | 10/13/2020 12:57 PM |
Terminations | Termination Effective Date | Insert | New Registration | | | 10/13/2020 12:57 PM |
Terminations | Termination Reason | Insert | New Registration | | | 10/13/2020 12:57 PM |