340B Drug Pricing Program Database


CAH511315-11 POTOMAC VALLEY HOSPITAL (Active) - information as of 5/6/2025 11:13:45 PM

Main Details
POTOMAC VALLEY HOSPITAL
PAIN MANAGEMENT OF PVH - Pain Management
Critical Access Hospital
Yes
CAH511315-11
511315


Additional Details
Active
10/8/2021
1/1/2022
10/12/2021
8/12/2024

Contacts

West Virginia University Healthcare
Justin Gibson, VP of Finance-North Region
(304) 598-4256

WVU Medicine
Jessica Ileen Calderone, Enterprise 340B Program Manager
(304) 598-4000 Ext: 70847

Addresses

131 STAGGS LN
STE 2
KEYSER, WV 26726-7003

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
WV 1912979873,1770536112,1467090449,1902444987,1063649606
OH 1912979873,1770536112,1467090449,1902444987,1063649606
PA 1912979873,1770536112,1467090449,1902444987,1063649606
VA 1912979873,1770536112,1467090449,1902444987,1063649606
KY 1912979873,1770536112,1467090449,1902444987,1063649606
Shipping Addresses

West Virginia United Health System Inc DBA Enterprise Pharmacy Solutions
781 Chestnut Ridge Rd
Suite 600
Morgantown, WV 26505-0015
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
CAH511315-01ChildCAHPOTOMAC VALLEY HOSPITALPVH RHC Riverside32 2nd StPiedmontWVActive
CAH511315-02ChildCAHPOTOMAC VALLEY HOSPITALPVH RHC Elk Garden48 Oak StreetElk GardenWVTerminated
CAH511315-04ChildCAHPOTOMAC VALLEY HOSPITALPVH - MOB- General Surgery - General Surgery78 Pin Oak LaneKeyserWVTerminated
CAH511315-05ChildCAHPOTOMAC VALLEY HOSPITALPVH-MOB-WOUND CARE - WOUND CARE88 PIN OAK LANEKEYSERWVActive
CAH511315-06ChildCAHPOTOMAC VALLEY HOSPITALPVH - Cardiology of PVH - Cardiology131 Staggs LaneKeyserWVActive
CAH511315-07ChildCAHPOTOMAC VALLEY HOSPITALPVH-MOB Family Medicine - Family Medicine78 Pin Oak LaneKeyserWVTerminated
CAH511315-08ChildCAHPOTOMAC VALLEY HOSPITALPVH-MOB-ORTHO - ORTHOPEDIC HOSPITALIST SERVICES78 PIN OAK LANE, SUITE 3KEYSERWVTerminated
CAH511315-09ChildCAHPOTOMAC VALLEY HOSPITALUROLOGY CLINIC - Urology131 Staggs LaneKEYSERWVActive
CAH511315-10ChildCAHPOTOMAC VALLEY HOSPITALORTHOPEDICS OF PVH - Orthopedic Clinic25 Kight DriveKEYSERWVActive
CAH511315-11ChildCAHPOTOMAC VALLEY HOSPITALPAIN MANAGEMENT OF PVH - Pain Management131 STAGGS LNKEYSERWVActive
CAH511315-12ChildCAHPOTOMAC VALLEY HOSPITALPOTOMAC VALLEY FAMILY PRACTICE - Family Medicine514 NEW CREEK HWYKEYSERWVActive
CAH511315-13ChildCAHPOTOMAC VALLEY HOSPITALPOTOMAC VALLEY FAMILY MED- BEHAVIOR - Behavioral Health139 Plaza DriveKEYSERWVActive
CAH511315-14ChildCAHPOTOMAC VALLEY HOSPITALRural Health Clinic II - Ft Ashby - Pediatrics10261 Frankfort HighwayFort AshbyWVTerminated
CAH511315-15ChildCAHPOTOMAC VALLEY HOSPITALRural Health Clinic III - Pulmonology78 Pin Oak LaneKeyserWVActive
CAH511315-16ChildCAHPOTOMAC VALLEY HOSPITALRural Health Clinic III - Family Medicine78 Pin Oak LaneKeyserWVActive
CAH511315-17ChildCAHPOTOMAC VALLEY HOSPITALRural Health Clinic III - General Surgery78 Pin Oak LaneKeyserWVActive
CAH511315-18ChildCAHPOTOMAC VALLEY HOSPITALRural Health Clinic II - Ft Ashby - Family Medicine10261 Frankfort HighwayFort AshbyWVActive
CAH511315-19ChildCAHPOTOMAC VALLEY HOSPITALRural Health Clinic III - PVH Emergency Medicine Urgent Care131 Plaza DriveKeyserWVActive
CAH511315-20ChildCAHPOTOMAC VALLEY HOSPITALRural Health Clinic II - Pulmonology10261 Frankfort HighwayFort AshbyWVActive
CAH511315-21ChildCAHPOTOMAC VALLEY HOSPITALPVH Podiatry - Podiatry131 Staggs LaneKeyserWVActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsAuthorizing OfficialUpdateProfile Change RequestGibson, Justin VP of Finance-North Region West Virginia University Healthcare 3045984085Gibson, Justin VP of Finance-North Region West Virginia University Healthcare 304598425610/21/2024 4:34 PM
ContactsSigned ByUpdateProfile Change RequestGibson, Justin VP of Finance-North Region West Virginia University Healthcare 3045984085Gibson, Justin VP of Finance-North Region West Virginia University Healthcare 304598425610/21/2024 4:34 PM
AddressesShipping AddressInsertGroup Change Request West Virginia United Health System Inc DBA Enterprise Pharmacy Solutions 781 Chestnut Ridge Rd Suite 600 Morgantown, WV 26505-001510/8/2024 8:03 AM
DetailsLast Recertification DateUpdateRecertification8/29/2023 1:56:32 PM8/12/2024 3:43:16 PM8/12/2024 3:43 PM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request3810000637 (WV) 6/4/2024 8:07 PM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request005025300 (MD) 5/31/2024 6:07 PM
Medicaid BillingNPI: NumberDeleteGroup Change Request1912979873 (MD) 5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 17705361125/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request WV5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 14670904495/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request WV5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19024449875/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request WV5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 10636496065/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request WV5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19129798735/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request OH5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 17705361125/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request OH5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 14670904495/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request OH5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19024449875/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request OH5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 10636496065/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request OH5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19129798735/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request PA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 17705361125/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request PA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 14670904495/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request PA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19024449875/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request PA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 10636496065/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request PA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19129798735/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request VA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 17705361125/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request VA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 14670904495/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request VA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19024449875/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request VA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 10636496065/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request VA5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19129798735/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request KY5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 17705361125/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request KY5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 14670904495/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request KY5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19024449875/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request KY5/31/2024 6:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 10636496065/31/2024 6:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request KY5/31/2024 6:07 PM
ContactsPrimary ContactUpdateProfile Change RequestCalderone, Jessica Ileen Enterprise 340B Program Manager WVU Medicine 7248755615Calderone, Jessica Ileen Enterprise 340B Program Manager WVU Medicine 3045984000-708479/27/2023 1:59 PM
DetailsLast Recertification DateUpdateRecertification8/31/2022 12:19:12 PM8/29/2023 1:56:32 PM8/29/2023 1:56 PM
DetailsLast Recertification DateUpdateRecertification 8/31/2022 12:19:12 PM8/31/2022 12:19 PM
ContactsPrimary ContactUpdateGroup Change RequestCalderone, Jessica Enterprise 340B Program Manager WVU Medicine 7248755615Calderone, Jessica Ileen Enterprise 340B Program Manager WVU Medicine 72487556151/24/2022 9:08 AM
ContactsPrimary ContactUpdateGroup Change RequestFamoso, Karen Lynn Enterprise Director, Compliance and Business Operations WVU Medicine 3042812986Calderone, Jessica Enterprise 340B Program Manager WVU Medicine 72487556151/24/2022 7:38 AM
DetailsStateUpdate ApprovedActive1/1/2022 12:01 AM
ContactsSigned ByInsertNew Registration Gibson, Justin VP of Finance-North Region West Virginia University Healthcare 304598408510/12/2021 7:42 AM
Details340B IDUpdateNew Registration CAH511315-1110/12/2021 7:42 AM
DetailsEntity SubnameUpdateNew RegistrationPAIN MANAGEMENT OF PVHPAIN MANAGEMENT OF PVH - Pain Management10/12/2021 7:42 AM
DatesParticipating Approval DateUpdateNew Registration 10/12/2021 7:42:31 AM10/12/2021 7:42 AM
DetailsStateUpdateNew RegistrationPendingApproved10/12/2021 7:42 AM
DatesSigned By DateUpdateNew Registration 10/10/2021 5:46:40 AM10/12/2021 7:42 AM
DatesStart DateUpdateNew Registration 1/1/2022 12:00:00 AM10/12/2021 7:42 AM
AddressesMain AddressInsertNew Registration  131 STAGGS LN STE 2 KEYSER, WV 26726-700310/8/2021 5:00 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False10/8/2021 5:00 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 00502530010/8/2021 5:00 PM
Medicaid BillingMedicaid: StateInsertNew Registration MD10/8/2021 5:00 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False10/8/2021 5:00 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 381000063710/8/2021 5:00 PM
Medicaid BillingMedicaid: StateInsertNew Registration WV10/8/2021 5:00 PM
Medicaid BillingNPI: NumberInsertNew Registration 191297987310/8/2021 5:00 PM
Medicaid BillingNPI: StateInsertNew Registration MD10/8/2021 5:00 PM
Medicaid BillingNPI: NumberInsertNew Registration 191297987310/8/2021 5:00 PM
Medicaid BillingNPI: StateInsertNew Registration WV10/8/2021 5:00 PM
ContactsAuthorizing OfficialInsertNew Registration Gibson, Justin VP of Finance-North Region West Virginia University Healthcare 304598408510/8/2021 5:00 PM
ContactsPrimary ContactInsertNew Registration Famoso, Karen Lynn Enterprise Director, Compliance and Business Operations WVU Medicine 304281298610/8/2021 5:00 PM
DetailsAssistance Received From DateInsertNew Registration  10/8/2021 5:00 PM
DetailsAssistance Received To DateInsertNew Registration  10/8/2021 5:00 PM
DetailsLast Recertification DateInsertNew Registration  10/8/2021 5:00 PM
DetailsGrant NumberInsertNew Registration  10/8/2021 5:00 PM
Details340B IDInsertNew Registration  10/8/2021 5:00 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  10/8/2021 5:00 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  10/8/2021 5:00 PM
DetailsMedicare Provider NumberInsertNew Registration 51131510/8/2021 5:00 PM
DetailsEntity NameInsertNew Registration POTOMAC VALLEY HOSPITAL10/8/2021 5:00 PM
DetailsNOFO NumberInsertNew Registration  10/8/2021 5:00 PM
DetailsProgram CodeInsertNew Registration CAH10/8/2021 5:00 PM
DetailsEntity SubnameInsertNew Registration PAIN MANAGEMENT OF PVH10/8/2021 5:00 PM
DatesParticipating Approval DateInsertNew Registration  10/8/2021 5:00 PM
DetailsStateInsertNew Registration Pending10/8/2021 5:00 PM
DatesRegistration DateInsertNew Registration 10/8/2021 5:00:47 PM10/8/2021 5:00 PM
DatesSigned By DateInsertNew Registration  10/8/2021 5:00 PM
DatesStart DateInsertNew Registration  10/8/2021 5:00 PM
TerminationsTermination CommentsInsertNew Registration  10/8/2021 5:00 PM
TerminationsTermination DateInsertNew Registration  10/8/2021 5:00 PM
TerminationsTermination Effective DateInsertNew Registration  10/8/2021 5:00 PM
TerminationsTermination ReasonInsertNew Registration  10/8/2021 5:00 PM