Covered Entity Details

RRC510050-05 WHEELING HOSPITAL (Active) - information as of 5/1/2025 11:49:21 PM

Main Details

Name

WHEELING HOSPITAL

Subdivision Name

Obstetrics & Gynecology

Type

Rural Referral Center

Rural

Yes

340B ID

RRC510050-05

Medicare Provider Number

510050

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/5/2022

Participating Start Date

4/1/2022

Participating Approval Date

1/25/2022

Last Recertification Date

8/23/2024

Contacts

Authorizing Official

WVU Medicine Wheeling Hospital
Heidi Porter L Porter, Vice President of Quality and Regulatory Affairs
(304) 243-8377

Primary Contact

Wheeling Hospital
Robert Keith Simons, Director Of Pharmacy
(304) 243-3019

Addresses

Street Address

30 Medical Park
Wheeling, WV 26003

Billing Address
Same as Street Address

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
OH		1104821305,1114913449
WV		1104821305,1114913449
PA		1114913449,1104821305
VA		1114913449,1104821305
KY		1114913449,1104821305

Shipping Addresses

Shipping Address 1

West Virginia United Health System Inc DBA Enterprise Pharmacy Solutions
781 Chestnut Ridge Rd
SUITE 600
MORGANTOWN, WV 26505-0015

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
RRC510050-01	Child	RRC	WHEELING HOSPITAL	Family Medicine - Family Medicine	40 Medical Park	Wheeling	WV	Active
RRC510050-02	Child	RRC	WHEELING HOSPITAL	HVI-50 - Cardiothoracic Surgery	10 Medical Park	Wheeling	WV	Terminated
RRC510050-03	Child	RRC	WHEELING HOSPITAL	HVI-69 - Cardiovascular Disease	10 Medical Park	Wheeling	WV	Active
RRC510050-04	Child	RRC	WHEELING HOSPITAL	Abbott - Orthopedic Surgery	10 Medical Park	Wheeling	WV	Active
RRC510050-05	Child	RRC	WHEELING HOSPITAL	Obstetrics & Gynecology	30 Medical Park	Wheeling	WV	Active
RRC510050-06	Child	RRC	WHEELING HOSPITAL	Pediatrics	30 Medical Park	Wheeling	WV	Active
RRC510050-07	Child	RRC	WHEELING HOSPITAL	Neurology	20 Medical Park	Wheeling	WV	Active
RRC510050-08	Child	RRC	WHEELING HOSPITAL	Family Medicine	20 Medical Park	Wheeling	WV	Active
RRC510050-09	Child	RRC	WHEELING HOSPITAL	DeCuba - Sports Medicine	10 Medical Park	Wheeling	WV	Terminated
RRC510050-10	Child	RRC	WHEELING HOSPITAL	Family Medicine	20 Medical Park	Wheeling	WV	ToBeTerminated
RRC510050-11	Child	RRC	WHEELING HOSPITAL	Surgery	20 Medical Park	Wheeling	WV	Active
RRC510050-12	Child	RRC	WHEELING HOSPITAL	Zyznewsky - Neurology	40 Medical Park	Wheeling	WV	Terminated
RRC510050-13	Child	RRC	WHEELING HOSPITAL	Plastic Surgery	40 Medical Park	Wheeling	WV	Active
RRC510050-14	Child	RRC	WHEELING HOSPITAL	Andreini - Orthopedics	1 Medical Park	Wheeling	WV	Terminated
RRC510050-15	Child	RRC	WHEELING HOSPITAL	Pain Management	40 Medical Park	Wheeling	WV	Active
RRC510050-16	Child	RRC	WHEELING HOSPITAL	Internal Medicine	40 Medical Park	Wheeling	WV	Active
RRC510050-17	Child	RRC	WHEELING HOSPITAL	Medical Oncology	40 Medical Park	Wheeling	WV	Active
RRC510050-18	Child	RRC	WHEELING HOSPITAL	Podiatry	40 Medical Park	Wheeling	WV	Active
RRC510050-19	Child	RRC	WHEELING HOSPITAL	GI center - Gastroenterology	30 Medical Park	Wheeling	WV	Active
RRC510050-20	Child	RRC	WHEELING HOSPITAL	Bariatric surgery	20 Medical Park	Wheeling	WV	Active
RRC510050-21	Child	RRC	WHEELING HOSPITAL	Melanoma Center - Melanoma detection and treatment	1 Medical Park	Wheeling	WV	Active
RRC510050-22	Child	RRC	WHEELING HOSPITAL	HVI Cardiothoracic Surgery	10 Medical Park	Wheeling	WV	Active
RRC510050-23	Child	RRC	WHEELING HOSPITAL	Interventional Cardiology - Interventional Cardiology	20 Medical Park	Wheeling	WV	Active
RRC510050-25	Child	RRC	WHEELING HOSPITAL	Family Medicine	58 16th street	Wheeling	WV	Active
RRC510050-26	Child	RRC	WHEELING HOSPITAL	Endocrinology	58 16th street	Wheeling	WV	Active
RRC510050-27	Child	RRC	WHEELING HOSPITAL	Vargo - Transitional Care Center	1 Medical Park	Wheeling	WV	Active
RRC510050-28	Child	RRC	WHEELING HOSPITAL	Podiatry	58 16th Street	Wheeling	WV	Active
RRC510050-29	Child	RRC	WHEELING HOSPITAL	Obstetrics & Gynecology	30 Medical Park	Wheeling	WV	ToBeTerminated
RRC510050-30	Child	RRC	WHEELING HOSPITAL	Blosser-Paxton - Pediatrics	30 Medical Park	Wheeling	WV	Terminated
RRC510050-31	Child	RRC	WHEELING HOSPITAL	Obstetrics & Gynecology	30 Medical Park	Wheeling	WV	ToBeTerminated
RRC510050-32	Child	RRC	WHEELING HOSPITAL	Urval - Internal Medicine	58 - 16th Street	Wheeling	WV	Terminated
RRC510050-33	Child	RRC	WHEELING HOSPITAL	HVI-90 Suite 300 - Cardiology Surgery	10 Medical Park	Wheeling	WV	Terminated
RRC510050-34	Child	RRC	WHEELING HOSPITAL	Rosario - Family Medicine	58 16th street	Wheeling	WV	Terminated
RRC510050-35	Child	RRC	WHEELING HOSPITAL	Urology	20 Medical Park	Wheeling	WV	Active
RRC510050-36	Child	RRC	WHEELING HOSPITAL	Schiffler Radiation Oncology - Radiation Oncology - Outpatient	40 Medical Park	Wheeling	WV	Active
RRC510050-37	Child	RRC	WHEELING HOSPITAL	HVI at Wheeling Clinic - Cardiology	58 - 16th Street	Wheeling	WV	Terminated
RRC510050-38	Child	RRC	WHEELING HOSPITAL	Family Medicine	58 16th street	Wheeling	WV	ToBeTerminated
RRC510050-39	Child	RRC	WHEELING HOSPITAL	Breast Center	40 Medical Park	Wheeling	WV	Active
RRC510050-40	Child	RRC	WHEELING HOSPITAL	Pulmonology	58 16th street	Wheeling	WV	Active
RRC510050-41	Child	RRC	WHEELING HOSPITAL	Behavioral Medicine - Neuropsychology	10 Medical Park	Wheeling	WV	Active
RRC510050-42	Child	RRC	WHEELING HOSPITAL	Urogynecology - Urogynecology	30 Medical Park	Wheeling	WV	Active
RRC510050-43	Child	RRC	WHEELING HOSPITAL	Infectious Disease - Infectious Disease	40 Medical Park	Wheeling	WV	Active
RRC510050-44	Child	RRC	WHEELING HOSPITAL	WELLSBURG CLINIC - Endocrinology	1423 COMMERCE ST	WELLSBURG	WV	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Main Address	Update	Change Request	30 Medical Park Tower 3 SUITE 232 Wheeling, WV 26003	30 Medical Park Wheeling, WV 26003	4/29/2025 10:28 AM
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	10/25/2024 7:38 AM
Addresses	Main Address	Update	Change Request	30 Medical Park Tower 3 219 Wheeling, WV 26003	30 Medical Park Tower 3 SUITE 232 Wheeling, WV 26003	10/16/2024 7:52 AM
Details	Entity Subname	Update	Change Request	Bala - Obstetrics & Gynecology	Obstetrics & Gynecology	10/16/2024 7:52 AM
Details	Last Recertification Date	Update	Recertification	9/11/2023 3:21:47 PM	8/23/2024 9:38:02 AM	8/23/2024 9:38 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	9384750 (OH)		6/5/2024 1:20 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	0001131000 (WV)		6/5/2024 1:20 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114913449	6/5/2024 1:20 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	6/5/2024 1:20 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114913449	6/5/2024 1:20 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	6/5/2024 1:20 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114913449	6/5/2024 1:20 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	6/5/2024 1:20 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114913449	6/5/2024 1:20 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	6/5/2024 1:20 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1114913449	6/5/2024 1:20 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	6/5/2024 1:20 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1104821305	6/5/2024 1:20 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	6/5/2024 1:20 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1104821305	6/5/2024 1:20 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	6/5/2024 1:20 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1104821305	6/5/2024 1:20 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	6/5/2024 1:20 PM
Details	Last Recertification Date	Update	Recertification	9/8/2022 10:57:50 AM	9/11/2023 3:21:47 PM	9/11/2023 3:21 PM
Contacts	Authorizing Official	Update	AO Change Request	Wenger, Joseph August Chief Financial Officer Wheeling Hospital 3042433801	Porter, Heidi Porter L Vice President of Quality and Regulatory Affairs WVU Medicine Wheeling Hospital 3042438377	10/18/2022 4:26 PM
Details	Last Recertification Date	Update	Recertification		9/8/2022 10:57:50 AM	9/8/2022 10:57 AM
Contacts	Authorizing Official	Update	AO Change Request	Murdy, James Brian Chief Administrative Officer Wheeling Hospital 3042433681	Wenger, Joseph August Chief Financial Officer Wheeling Hospital 3042433801	5/28/2022 8:30 AM
Details	State	Update		Approved	Active	4/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Murdy, James Brian Chief Administrative Officer Wheeling Hospital 3042433681	1/25/2022 2:32 PM
Details	340B ID	Update	New Registration		RRC510050-05	1/25/2022 2:32 PM
Details	Entity Subname	Update	New Registration	Bala	Bala - Obstetrics & Gynecology	1/25/2022 2:32 PM
Dates	Participating Approval Date	Update	New Registration		1/25/2022 2:32:01 PM	1/25/2022 2:32 PM
Details	State	Update	New Registration	Pending	Approved	1/25/2022 2:32 PM
Dates	Signed By Date	Update	New Registration		1/6/2022 3:25:51 PM	1/25/2022 2:32 PM
Dates	Start Date	Update	New Registration		4/1/2022 12:00:00 AM	1/25/2022 2:32 PM
Addresses	Main Address	Insert	New Registration		30 Medical Park Tower 3 219 Wheeling, WV 26003	1/5/2022 5:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/5/2022 5:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		9384750	1/5/2022 5:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OH	1/5/2022 5:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/5/2022 5:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0001131000	1/5/2022 5:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		WV	1/5/2022 5:29 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1104821305	1/5/2022 5:29 PM
Medicaid Billing	NPI: State	Insert	New Registration		OH	1/5/2022 5:29 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1104821305	1/5/2022 5:29 PM
Medicaid Billing	NPI: State	Insert	New Registration		WV	1/5/2022 5:29 PM
Contacts	Authorizing Official	Insert	New Registration		Murdy, James Brian Chief Administrative Officer Wheeling Hospital 3042433681	1/5/2022 5:29 PM
Contacts	Primary Contact	Insert	New Registration		Simons, Robert Keith Director Of Pharmacy Wheeling Hospital 3042433019	1/5/2022 5:29 PM
Details	Assistance Received From Date	Insert	New Registration			1/5/2022 5:29 PM
Details	Assistance Received To Date	Insert	New Registration			1/5/2022 5:29 PM
Details	Last Recertification Date	Insert	New Registration			1/5/2022 5:29 PM
Details	Grant Number	Insert	New Registration			1/5/2022 5:29 PM
Details	340B ID	Insert	New Registration			1/5/2022 5:29 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/5/2022 5:29 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/5/2022 5:29 PM
Details	Medicare Provider Number	Insert	New Registration		510050	1/5/2022 5:29 PM
Details	Entity Name	Insert	New Registration		WHEELING HOSPITAL	1/5/2022 5:29 PM
Details	NOFO Number	Insert	New Registration			1/5/2022 5:29 PM
Details	Program Code	Insert	New Registration		RRC	1/5/2022 5:29 PM
Details	Entity Subname	Insert	New Registration		Bala	1/5/2022 5:29 PM
Dates	Participating Approval Date	Insert	New Registration			1/5/2022 5:29 PM
Details	State	Insert	New Registration		Pending	1/5/2022 5:29 PM
Dates	Registration Date	Insert	New Registration		1/5/2022 5:29:05 PM	1/5/2022 5:29 PM
Dates	Signed By Date	Insert	New Registration			1/5/2022 5:29 PM
Dates	Start Date	Insert	New Registration			1/5/2022 5:29 PM
Terminations	Termination Comments	Insert	New Registration			1/5/2022 5:29 PM
Terminations	Termination Date	Insert	New Registration			1/5/2022 5:29 PM
Terminations	Termination Effective Date	Insert	New Registration			1/5/2022 5:29 PM
Terminations	Termination Reason	Insert	New Registration			1/5/2022 5:29 PM