Covered Entity Details

CAH341315-06 Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital (Active) - information as of 5/28/2025 5:19:09 PM

Main Details

Name

Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital

Subdivision Name

CFV BLADEN MEDICAL ASSOCIATES - BMA White Lake

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH341315-06

Medicare Provider Number

341315

Outpatient Facility Provider Number

343469

Additional Details

Current Program Status

Active

Registration Date

10/13/2020

Participating Start Date

1/1/2021

Participating Approval Date

10/14/2020

Last Recertification Date

8/16/2024

Contacts

Authorizing Official

Bladen County Hospital
Spencer Lowell Cummings, President
(910) 862-5149

Primary Contact

Bladen Healthcare, LLC dba CFVHS-Bladen County Hospital
Karen Gentry, Pharmacy Director
(910) 862-5157

Addresses

Street Address

273 WHITE LAKE DR
ELIZABETHTOWN, NC 28337-6885

Billing Address

CFV-Bladen County Hospital
PO Box 398
Elizabethtown, NC 28337

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
NC	1528559671	1528559671

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
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
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

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
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