| Addresses | Shipping Address | Insert | Change Request | | Shenandoah Pharmacy – Winchester
1330 Amherst Street
Attn: Pharmacy
Winchester, VA 22601 | 4/11/2025 11:55 AM |
| Details | Last Recertification Date | Update | Recertification | 2/13/2024 9:37:39 AM | 2/28/2025 2:51:06 PM | 2/28/2025 2:51 PM |
| Addresses | Billing Address | Update | Recertification | Shenandoah Pharmacy
99 Tavern Rd
Martinsburg, WV 25402 | Shenandoah Valley Medical System, Inc.
PO BOX 1146
Martinsburg, WV 25402 | 2/13/2024 9:37 AM |
| Addresses | Shipping Address | Delete | Recertification | Shenandoah Pharmacy
99 Tavern Rd
Martinsburg, WV 25401 | | 2/13/2024 9:37 AM |
| Addresses | Shipping Address | Insert | Recertification | | Shenandoah Pharmacy
99 Tavern Rd
Attn: Pharmacy
Martinsburg, WV 25401 | 2/13/2024 9:37 AM |
| Details | Last Recertification Date | Update | Recertification | 2/15/2023 10:42:22 AM | 2/13/2024 9:37:39 AM | 2/13/2024 9:37 AM |
| Addresses | Main Address | Update | Change Request |
422 W Burke St
Martinsburg, WV 25401-2732 |
422 W Burke St
Martinsburg, WV 25401 | 3/16/2023 10:01 AM |
| Addresses | Billing Address | Update | Recertification | Shenandoah Pharmacy
99 Tavern Rd
Martinsburg, WV 25401 | Shenandoah Pharmacy
99 Tavern Rd
Martinsburg, WV 25402 | 2/15/2023 10:42 AM |
| Details | Last Recertification Date | Update | Recertification | 2/9/2022 2:53:59 PM | 2/15/2023 10:42:22 AM | 2/15/2023 10:42 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Hassing, Michael
CEO
Shenandoah Valley Medical System, Inc
3045962610-1062 | Hassing, Michael
CEO
Shenandoah Valley Medical System, Incorporated
3045962610-1062 | 10/27/2022 10:12 AM |
| Contacts | Signed By | Update | Profile Change Request | Hassing, Michael
CEO
Shenandoah Valley Medical System, Inc
3045962610-1062 | Hassing, Michael
CEO
Shenandoah Valley Medical System, Incorporated
3045962610-1062 | 10/27/2022 10:12 AM |
| Details | Last Recertification Date | Update | Recertification | | 2/9/2022 2:53:59 PM | 2/9/2022 2:53 PM |
| Details | State | Update | | Approved | Active | 1/1/2022 12:01 AM |
| Contacts | Signed By | Insert | New Registration | | Hassing, Michael
CEO
Shenandoah Valley Medical System, Inc
3045962610-1062 | 10/13/2021 7:11 AM |
| Details | 340B ID | Update | New Registration | | CH03090X | 10/13/2021 7:11 AM |
| Dates | Participating Approval Date | Update | New Registration | | 10/13/2021 7:11:58 AM | 10/13/2021 7:11 AM |
| Details | State | Update | New Registration | Pending | Approved | 10/13/2021 7:11 AM |
| Dates | Signed By Date | Update | New Registration | | 10/12/2021 11:36:31 AM | 10/13/2021 7:11 AM |
| Dates | Start Date | Update | New Registration | | 1/1/2022 12:00:00 AM | 10/13/2021 7:11 AM |
| Addresses | Main Address | Insert | New Registration | |
422 W Burke St
Martinsburg, WV 25401-2732 | 10/12/2021 11:36 AM |
| Addresses | Billing Address | Insert | New Registration | | Shenandoah Pharmacy
99 Tavern Rd
Martinsburg, WV 25401 | 10/12/2021 11:36 AM |
| Addresses | Shipping Address | Insert | New Registration | | Shenandoah Pharmacy
99 Tavern Rd
Martinsburg, WV 25401 | 10/12/2021 11:36 AM |
| Contacts | Authorizing Official | Insert | New Registration | | Hassing, Michael
CEO
Shenandoah Valley Medical System, Inc
3045962610-1062 | 10/12/2021 11:36 AM |
| Contacts | Primary Contact | Insert | New Registration | | McCahan, Stephen W
Pharmacy Director
Shenandoah Valley Medical System, Inc
3045962244 | 10/12/2021 11:36 AM |
| Details | Assistance Received From Date | Insert | New Registration | | | 10/12/2021 11:36 AM |
| Details | Assistance Received To Date | Insert | New Registration | | | 10/12/2021 11:36 AM |
| Details | Last Recertification Date | Insert | New Registration | | | 10/12/2021 11:36 AM |
| Details | Grant Number | Insert | New Registration | | H80CS00781 | 10/12/2021 11:36 AM |
| Details | 340B ID | Insert | New Registration | | | 10/12/2021 11:36 AM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 10/12/2021 11:36 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 10/12/2021 11:36 AM |
| Details | Medicare Provider Number | Insert | New Registration | | | 10/12/2021 11:36 AM |
| Details | Entity Name | Insert | New Registration | | Shenandoah Valley Medical System, Incorporated | 10/12/2021 11:36 AM |
| Details | NOFO Number | Insert | New Registration | | | 10/12/2021 11:36 AM |
| Details | Program Code | Insert | New Registration | | CH | 10/12/2021 11:36 AM |
| Details | Entity Subname | Insert | New Registration | | Shenandoah Community Health Burke St Elementary | 10/12/2021 11:36 AM |
| Dates | Participating Approval Date | Insert | New Registration | | | 10/12/2021 11:36 AM |
| Details | State | Insert | New Registration | | Pending | 10/12/2021 11:36 AM |
| Dates | Registration Date | Insert | New Registration | | 10/12/2021 11:36:28 AM | 10/12/2021 11:36 AM |
| Dates | Signed By Date | Insert | New Registration | | | 10/12/2021 11:36 AM |
| Dates | Start Date | Insert | New Registration | | | 10/12/2021 11:36 AM |
| Terminations | Termination Comments | Insert | New Registration | | | 10/12/2021 11:36 AM |
| Terminations | Termination Date | Insert | New Registration | | | 10/12/2021 11:36 AM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 10/12/2021 11:36 AM |
| Terminations | Termination Reason | Insert | New Registration | | | 10/12/2021 11:36 AM |