Yes
| OH | | 1144228305 |
| WV | | 1144228305 |
| PA | | 1144228305 |
| VA | | 1144228305 |
| KY | | 1144228305 |
West Virginia United Health System Inc DBA Enterprise Pharmacy Solutions
781 Chestnut Ridge Rd
Suite 600
Morgantown, WV 26505-0015
| Contract Detail | ALLIED HEALTH SERVICES INC. | DBA ALLIED HEALTH SOLUTIONS |
3040 UNIVERSITY AVE STE 1400
| MORGANTOWN | WV | 26505-3381 | 07/01/2021 | 10/01/2021 | | 12/16/2023 | 12/16/2023 |
| Contract Detail | CVS CAREMARK | DBA CVS/CAREMARK OR CF# 11506 |
1 GREAT VALLEY BOULEVARD
| WILKES BARRE | PA | 18706 | 10/17/2022 | 01/01/2023 | | | 01/01/2023 |
| Contract Detail | CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC | DBA CVS/CAREMARK 48067 |
1780 WALL ST
| MT PROSPECT | IL | 60056 | 10/17/2022 | 01/01/2023 | | | 01/01/2023 |
| Contract Detail | KROGER COLUMBUS CENTRAL FILL #019 | 2270 RICKENBACKER PKWY W |
| COLUMBUS | OH | 43217 | 10/10/2024 | 01/01/2025 | | | 01/01/2025 |
| Contract Detail | KROGER PHARMACY #16977 | 1300 LAFAYETTE AVENUE |
| MOUNDSVILLE | WV | 26041 | 07/14/2021 | 10/01/2021 | | | 10/01/2021 |
| Contract Detail | KROGER PHARMACY N-562 | 200 MOUNT DE CHANTAL RD |
| WHEELING | WV | 26003-6563 | 07/14/2021 | 10/01/2021 | | | 10/01/2021 |
| Contract Detail | MEDICAL PARK PHARMACY | 1 MEDICAL PARK |
| WHEELING | WV | 26003 | 01/16/2024 | 04/01/2024 | | | 04/01/2024 |
| Contract Detail | MOUNDSVILLE PHARMACY | 118 LAFAYETTE AVE |
| MOUNDSVILLE | WV | 26041-1029 | 07/14/2021 | 10/01/2021 | | | 10/01/2021 |
| Contract Detail | OHIO CVS STORES, L.L.C. | DBA: CVS/PHARMACY # 06271 |
68501 ADDIE WAY
| SAINT CLAIRSVILLE | OH | 43950 | 07/14/2021 | 10/01/2021 | | | 10/01/2021 |
| Contract Detail | PROCARE PHARMACY DIRECT, L.L.C. | DBA CVS/SPECIALTY OR CARELONRX SPECIALTY |
105 MALL BOULEVARD
| MONROEVILLE | PA | 15146 | 10/17/2022 | 01/01/2023 | | | 01/01/2023 |
| Contract Detail | WAL-MART CENTRAL FILL 10-2670 | 608 SPRING HILL DR # 3 SUITE 300 |
| SPRING | TX | 77386 | 10/12/2021 | 01/01/2022 | | | 01/01/2022 |
| Contract Detail | WAL-MART PHARMACY 10-2684 | 1142 SO. BRIDGE STREET |
| NEW MARTINSVILLE | WV | 26155 | 10/12/2021 | 01/01/2022 | | | 01/01/2022 |
| Contract Detail | WAL-MART PHARMACY 10-2852 | 10 WAL-MART DRIVE |
| MOUNDSVILLE | WV | 26041 | 10/12/2021 | 01/01/2022 | | | 01/01/2022 |
| Contract Detail | WAL-MART PHARMACY 10-5997 | 9600 PARKSOUTH CT. SUITE 100 |
| ORLANDO | FL | 32837 | 10/12/2021 | 01/01/2022 | | | 01/01/2022 |
| Contract Detail | WALGREEN CO. | WALGREENS #17949 |
120 JEFFERSON AVE
| MOUNDSVILLE | WV | 26041-1411 | 01/18/2022 | 04/01/2022 | | | 04/01/2022 |
| Contract Detail | WALGREEN CO. | WALGREENS #17319 |
111 KRUGER ST.
| WHEELING | WV | 26003-5120 | 10/17/2022 | 01/01/2023 | | | 01/01/2023 |
| Contract Detail | WALGREEN CO. | WALGREENS #19305 |
205 MARSHALL ST N
| BENWOOD | WV | 26031-1024 | 10/17/2022 | 01/01/2023 | | 04/29/2024 | 03/12/2025 |
| Contract Detail | Walgreens #21423 | Walgreens Central Fill #21423 |
6275 Winchester Blvd
| Canal WInchester | OH | 43110-6537 | 07/16/2024 | 10/01/2024 | | | 10/01/2024 |
| Contract Detail | WALMART PHARMACY 10-5169 | 2252 NORTH 8TH STREET |
SUITE A
| ROGERS | AR | 72756 | 01/17/2023 | 04/01/2023 | | | 04/01/2023 |
| Contract Detail | Walmart Pharmacy 10-7611 | 2501 Perry Rd |
| Plainfield | IN | 46168 | 10/13/2023 | 01/01/2024 | | | 01/01/2024 |
| Contract Detail | WEST VIRGINIA CVS PHARMACY, L.L.C. | DBA: CVS/PHARMACY # 06278 |
842 NATIONAL RD.
| WHEELING | WV | 26003 | 07/14/2021 | 10/01/2021 | | | 10/01/2021 |
| Contract Detail | WEST VIRGINIA CVS PHARMACY, L.L.C. | DBA: CVS/PHARMACY # 06277 |
1114 LAFAYETTE AVE
| MOUNDSVILLE | WV | 26041 | 07/14/2021 | 10/01/2021 | | | 10/01/2021 |
| Contract Detail | WEST VIRGINIA UNIVERSITY HOSPITALS, INC. | WVUH SPECIALTY PHARMACY & HOME INFUSION |
3040 UNIVERSITY AVE STE 1400
| MORGANTOWN | WV | 26505 | 12/05/2023 | 12/16/2023 | | | 12/16/2023 |
| DSH510013A | Child | DSH | REYNOLDS MEMORIAL HOSPITAL | REYNOLDS MEMORIAL HOSPITAL INC - Cancer Center | 901 JEFFERSON AVE | GLEN DALE | WV | Active |
| DSH510013B | Child | DSH | REYNOLDS MEMORIAL HOSPITAL | REYNOLDS MEMORIAL HOSPITAL INC - Family Medicine 90.04 | 426 8TH ST | GLEN DALE | WV | Active |
| DSH510013C | Child | DSH | REYNOLDS MEMORIAL HOSPITAL | REYNOLDS MEMORIAL HOSPITAL INC - Family Medicine 90.07 | 426 8TH ST | GLEN DALE | WV | Active |
| DSH510013D | Child | DSH | REYNOLDS MEMORIAL HOSPITAL | REYNOLDS MEMORIAL HOSPITAL INC - Internal Medicine 90.11 | 426 8TH ST | GLEN DALE | WV | Active |
| DSH510013E | Child | DSH | REYNOLDS MEMORIAL HOSPITAL | Internal Medicine - St. Clairsville 90.17 - Internal Medicine | 300 W Main St | St. Clairsville | OH | Terminated |
| DSH510013F | Child | DSH | REYNOLDS MEMORIAL HOSPITAL | RMH Neurosurgery - Neurosurgery | 426 8th Street | Glen Dale | WV | Active |
| DSH510013G | Child | DSH | REYNOLDS MEMORIAL HOSPITAL | RMH Pain Clinic - Pain Clinic | 426 8th Street | Glen Dale | WV | Active |
| DSH510013H | Child | DSH | REYNOLDS MEMORIAL HOSPITAL | RMH Family Medicine - Family Medicine 90.06 | 426 8th Street | Glen Dale | WV | Active |
| DSH510013J | Child | DSH | REYNOLDS MEMORIAL HOSPITAL | RMH Family Medicine - Family Medicine 90.04-2 | 426 8th Street | Glen Dale | WV | Active |
| 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 | 10/23/2024 7:25 AM |
| Details | Last Recertification Date | Update | Recertification | 8/29/2023 8:59:53 PM | 8/13/2024 3:31:05 PM | 8/13/2024 3:31 PM |
| Medicaid Billing | Medicaid: Number | Delete | Group Change Request | 7306507 (OH) | | 6/6/2024 8:50 AM |
| Medicaid Billing | Medicaid: Number | Delete | Group Change Request | 0001309000 (WV) | | 6/6/2024 8:50 AM |
| Medicaid Billing | Medicaid: Number | Delete | Group Change Request | 1007753520001 (PA) | | 6/6/2024 8:50 AM |
| Medicaid Billing | Medicaid: Number | Delete | Group Change Request | 1144228305 (VA) | | 6/6/2024 8:50 AM |
| Medicaid Billing | NPI: Number | Insert | Group Change Request | | 1144228305 | 6/6/2024 8:50 AM |
| Medicaid Billing | NPI: State | Insert | Group Change Request | | KY | 6/6/2024 8:50 AM |
| Details | Last Recertification Date | Update | Recertification | 8/30/2022 9:03:18 AM | 8/29/2023 8:59:53 PM | 8/29/2023 8:59 PM |
| Details | Last Recertification Date | Update | Recertification | 8/17/2021 8:40:33 AM | 8/30/2022 9:03:18 AM | 8/30/2022 9:03 AM |
| Details | Last Recertification Date | Update | Recertification | | 8/17/2021 8:40:33 AM | 8/17/2021 8:40 AM |
| Details | State | Update | | Approved | Active | 7/1/2021 12:01 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 6/3/2021 8:30 AM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 1144228305 | 6/3/2021 8:30 AM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | VA | 6/3/2021 8:30 AM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1144228305 | 6/3/2021 8:30 AM |
| Medicaid Billing | NPI: State | Insert | Change Request | | VA | 6/3/2021 8:30 AM |
| Contacts | Signed By | Insert | New Registration | | Inclan, Alex Craig
CFO
Reynolds Memorial Hospital
3048433240 | 4/6/2021 10:28 AM |
| Details | 340B ID | Update | New Registration | | DSH510013 | 4/6/2021 10:28 AM |
| Dates | Participating Approval Date | Update | New Registration | | 4/6/2021 10:28:13 AM | 4/6/2021 10:28 AM |
| Details | State | Update | New Registration | Pending | Approved | 4/6/2021 10:28 AM |
| Dates | Signed By Date | Update | New Registration | | 4/5/2021 12:34:27 PM | 4/6/2021 10:28 AM |
| Dates | Start Date | Update | New Registration | | 7/1/2021 12:00:00 AM | 4/6/2021 10:28 AM |
| Addresses | Main Address | Insert | New Registration | |
800 WHEELING AVENUE
GLEN DALE, WV 26038 | 4/5/2021 12:31 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 4/5/2021 12:31 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | 7306507 | 4/5/2021 12:31 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | OH | 4/5/2021 12:31 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 4/5/2021 12:31 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | 0001309000 | 4/5/2021 12:31 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | WV | 4/5/2021 12:31 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 4/5/2021 12:31 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | 1007753520001 | 4/5/2021 12:31 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | PA | 4/5/2021 12:31 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1144228305 | 4/5/2021 12:31 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | OH | 4/5/2021 12:31 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1144228305 | 4/5/2021 12:31 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | WV | 4/5/2021 12:31 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1144228305 | 4/5/2021 12:31 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | PA | 4/5/2021 12:31 PM |
| Contacts | Primary Contact | Insert | New Registration | | Kennon, Terry
Director of Pharmacy
Reynolds Memorial Hospital
3048433309 | 4/5/2021 12:31 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Inclan, Alex Craig
CFO
Reynolds Memorial Hospital
3048433240 | 4/5/2021 12:31 PM |
| Details | Assistance Received From Date | Insert | New Registration | | | 4/5/2021 12:31 PM |
| Details | Assistance Received To Date | Insert | New Registration | | | 4/5/2021 12:31 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 4/5/2021 12:31 PM |
| Details | Grant Number | Insert | New Registration | | | 4/5/2021 12:31 PM |
| Details | 340B ID | Insert | New Registration | | | 4/5/2021 12:31 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 4/5/2021 12:31 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 4/5/2021 12:31 PM |
| Details | Medicare Provider Number | Insert | New Registration | | 510013 | 4/5/2021 12:31 PM |
| Details | Entity Name | Insert | New Registration | | REYNOLDS MEMORIAL HOSPITAL | 4/5/2021 12:31 PM |
| Details | NOFO Number | Insert | New Registration | | | 4/5/2021 12:31 PM |
| Details | Program Code | Insert | New Registration | | DSH | 4/5/2021 12:31 PM |
| Details | Entity Subname | Insert | New Registration | | | 4/5/2021 12:31 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 4/5/2021 12:31 PM |
| Details | State | Insert | New Registration | | Pending | 4/5/2021 12:31 PM |
| Dates | Registration Date | Insert | New Registration | | 4/5/2021 12:31:30 PM | 4/5/2021 12:31 PM |
| Dates | Signed By Date | Insert | New Registration | | | 4/5/2021 12:31 PM |
| Dates | Start Date | Insert | New Registration | | | 4/5/2021 12:31 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 4/5/2021 12:31 PM |
| Terminations | Termination Date | Insert | New Registration | | | 4/5/2021 12:31 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 4/5/2021 12:31 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 4/5/2021 12:31 PM |