340B Drug Pricing Program Database


CH03308P RAINELLE MEDICAL CENTER (Terminated) - information as of 6/2/2025 8:30:40 AM

Main Details
RAINELLE MEDICAL CENTER
RMC Greenbrier Nephrology Center
HRSA-Funded Health Center
BPS-H80-030749
CH03308P
H80CS18278


Additional Details
Terminated
10/4/2022
1/1/2023
10/4/2022
2/1/2024

4/1/2025
Site closure

Contacts

Rainelle Medical Center, Inc.
KRISTI ATHA-RADER, CEO
(304) 438-6188 Ext: 1006

Rainelle Medical Center, Inc.
David R Yoakum, Pharmacy Director
(304) 438-6188 Ext: 1099

Addresses

289 Dawkins Drive
Lewisburg, WV 24901

Rainelle Medical Center
289 DAWKINS DR
LEWISBURG, WV 24901


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
WV1437772225,1235238122,13366618341225135536,1679820260,1609256676,1205823465,1730172297,1235622168,1083889323,1992250625,1003417023,1669476057,1417200445,1154424000,1366748196,1376837757,1467793091,1851407142,1285128272,1699768150,1518968031,1093368201,1003572488,1982825428,1487298584,1770685992,1669436853,1265705909,1467841148,1699903021,1235418005,1881456390,1932727971,1235238122,1336661834,1669212304,1801678925,1154177426,1497746416,1386634715,1912414954
VA14377722251003417023,1003572488,1083889323,1093368201,1154424000,1205823465,1225135536,1235418005,1235622168,1265705909,1285128272,1366748196,1376837757,1417200445,1467793091,1467841148,1487298584,1518968031,1609256676,1669436853,1669476057,1679820260,1699768150,1699903021,1730172297,1770685992,1851407142,1881456390,1932727971,1982825428,1992250625,1669212304,1801678925,1154177426,1497746416,1386634715,1912414954
Shipping Addresses

Same as Street Address
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH033080ActiveBPS-H80-005571RAINELLE MEDICAL CENTERRAINELLE MEDICAL CENTER176 Medical Center Drive RainelleWV
CH03308AActiveBPS-H80-010870RAINELLE MEDICAL CENTER, INC.Alderson Medical Center101 Railroad Ave AldersonWV
CH03308AAActiveBPS-H80-038340RAINELLE MEDICAL CENTERRupert Elementary School Wellness Center190 Crimson Tide Way CrawleyWV
CH03308BActiveBPS-H80-038339RAINELLE MEDICAL CENTER, INC.Eastern Greenbrier Health Center595 Spartan Ln LewisburgWV
CH03308CActiveBPS-H80-007360RAINELLE MEDICAL CENTER, INC.GREENBRIER WEST HIGH SCHOOL CLIN278 Cavalier Drive CHARMCOWV
CH03308DActiveBPS-H80-007328RAINELLE MEDICAL CENTER, INC.MEADOW BRIDGE SCH. BASED CLINIC870 Meadow Bridge Rd MEADOW BRIDGEWV
CH03308EActiveBPS-H80-006839RAINELLE MEDICAL CENTER, INC.WESTERN GREENBRIER MIDDLE SCHOOL315 Timberwolf Dr CRAWLEYWV
CH03308FActiveBPS-H80-018411RAINELLE MEDICAL CENTER, INC.White Sulphur Springs Health Center128 Community Lane White Sulphur SpringsWV
CH03308GActiveBPS-H80-017677RAINELLE MEDICAL CENTER, INC.Maxwelton Health Center390 Industrial Park Road MaxweltonWV
CH03308HActiveBPS-H80-035487RAINELLE MEDICAL CENTER, INC.Midland Trail Health Center26737 Midland Trail HicoWV
CH03308JActiveBPS-H80-035488RAINELLE MEDICAL CENTER, INC.Summers County Wellness Center181 Bobcat Drive HintonWV
CH03308KActiveBPS-H80-011344RAINELLE MEDICAL CENTER, INC.Rainelle Dental Center205 Medical Center Dr RainelleWV
CH03308LActiveBPS-H80-011210RAINELLE MEDICAL CENTER, INC.Meadow Bridge Clinic8971 Sewell Creek Rd Meadow BridgeWV
CH03308MActiveBPS-H80-024790Rainelle Medical Center, Inc.Lewisburg Health Center296 Fair Street LewisburgWV
CH03308NActiveBPS-H80-035728RAINELLE MEDICAL CENTERRMC Lewisburg Pediatrics and Family Health Center2140 N Jefferson St LewisburgWV
CH03308PTerminatedBPS-H80-030749RAINELLE MEDICAL CENTERRMC Greenbrier Nephrology Center289 Dawkins Drive LewisburgWV
CH03308QTerminatedBPS-H80-030347RAINELLE MEDICAL CENTERLewisburg Behavioral Health Center149 Goheen St LewisburgWV
CH03308RActiveBPS-H80-037173RAINELLE MEDICAL CENTERMobile Access Care Center (MACC)176 Medical Center Dr RainelleWV
CH03308STerminatedBPS-H80-031033RAINELLE MEDICAL CENTERRMC Greenbrier Nephrology Center - Alleghany117 Mall Rd CovingtonVA
CH03308TActiveBPS-H80-034280RAINELLE MEDICAL CENTERGreenbrier East High Wellness Center273 Spartan Ln Rm E101 LewisburgWV
CH03308UActiveBPS-H80-027942RAINELLE MEDICAL CENTERWhite Sulphur Springs Elementary School Wellness Center150 Reed St White Sulphur SpringsWV
CH03308VActiveBPS-H80-028198RAINELLE MEDICAL CENTERRainelle Elementary School Wellness Center701 Kanawha Ave RainelleWV
CH03308WActiveBPS-H80-038913RAINELLE MEDICAL CENTERLewisburg Behavioral Health38378 Midland Trail East UNIT B CaldwellWV
CH03308XActiveBPS-H80-027940RAINELLE MEDICAL CENTERAlderson Elementary School Wellness Center300 Chase St AldersonWV
CH03308YActiveBPS-H80-027943RAINELLE MEDICAL CENTERFrankford Elementary School Wellness Center21692 Seneca Trl N FrankfordWV
CH03308ZActiveBPS-H80-038711RAINELLE MEDICAL CENTERRupert Health Center458 Greenbrier St RupertWV
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH033080ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750201/01/2023  
CH033080ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201001/01/2023  
CH033080ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884901/01/2023  
CH033080ACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624101/01/2023 05/02/2024
CH033080ACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607501/01/2023  
CH033080ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282201/01/2023  
CH033080ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349201/01/2023  
CH033080ADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101
ORLANDOFL3280910/01/2024  
CH033080AHSSHCEXPEDIEN RX PHARMACY 5050 WESLEY RD STE 120
APOPKAFL3271201/01/2017  
CH033080ALDERSON PHARMACYJAMES K COLEMAN D B A P O BOX 450
105 RAILROAD AVENUE
ALDERSONWV24910-045005/10/2012 01/26/2016
CH033080AMAZON PHARMACY #0014500 S PLEASANT VALLEY RD STE 201
AUSTINTX78744-291110/01/2024 03/31/2025
CH033080AMAZON PHARMACY #0063620 PLAINFIELD RD
INDIANAPOLISIN46231-700310/01/2024 03/31/2025
CH033080AMAZON PHARMACY #008408 TECHNOLOGY PARKWAY BUILDING B, STE 101
COLLEGE STATIONTX7784510/01/2024 03/31/2025
CH033080AMAZON PHARMACY #0097469 KINGSPOINTE PKWY STE 400
ORLANDOFL3281910/01/2024 03/31/2025
CH033080AMAZON PHARMACY #0101331 E 6TH ST
CORONACA9287910/01/2024 03/31/2025
CH033080AZ PHARMACY, LLCDBA AMAZON PHARMACY #002 3809 E WATKINS ST
PHOENIXAZ8503404/01/2019 03/31/2025
CH033080BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771304/01/2024  
CH033080BIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267004/01/2024  
CH033080BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526104/01/2024  
CH033080BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522610/01/2024  
CH033080BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620310/01/2024  
CH033080CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/01/2022  
CH033080CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/01/2022  
CH033080CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/01/2022  
CH033080CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/01/2022  
CH033080CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/01/2022  
CH033080CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/01/2022  
CH033080CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/01/2022  
CH033080CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813307/01/2022  
CH033080CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237407/01/2022  
CH033080CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/01/2022  
CH033080CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870604/01/2021  
CH033080CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005604/01/2021  
CH033080CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/01/2022  
CH033080CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503304/01/2018  
CH033080DELIVERCARERX PHARMACY LLCDELIVERCARERX PHARMACY LLC 1471 E BUSINESS CENTER DR
STE 200
MT PROSPECTIL6005604/01/2018  
CH033080DOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K
GREENVILLESC29607-654104/01/2024  
CH033080ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111201/01/2023  
CH033080EXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313401/01/2023  
CH033080EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801601/01/2023  
CH033080EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607501/01/2023  
CH033080GENOA HEALTHCARE LLC804 INDUSTRIAL PARK RD ROOM 27
MAXWELTONWV2495710/01/2022  
CH033080GREENBRIER MED ARTS PHAR INC DBA ALLEGHA1117 S CRAIG AVE
COVINGTONVA24426-224604/01/2025  
CH033080GREENBRIER MED ARTS PHARMACY690 MAPLEWOOD AVE
LEWISBURGWV2490104/01/2025  
CH033080GREENBRIER MEDICAL ARTSPHARMACY INC., NORTH 3558 JEFFERSON ST N STE 1
LEWISBURGWV24901-573004/01/2025  
CH033080GREENBRIER MEDICAL ARTS PHARMACY, INC128 COMMUNITY LN
WHITE SULPHUR SPRINGSWV24986-110501/01/2017 08/19/2018
CH033080GREENBRIER MEDICAL ARTS PHARMACY, INC128 COMMUNITY LN
WHITE SULPHUR SPRINGSWV24986-110504/01/2025  
CH033080IC PHARMACY LLCAMAZON PHARMACY #004 34 35TH STREET
STE 4BSW, UNIT 28
BROOKLYNNY1123210/01/2024 03/31/2025
CH033080KROGER COLUMBUS CENTRAL FILL #0192270 RICKENBACKER PKWY W
COLUMBUSOH4321704/01/2025  
CH033080KROGER PHARMACY #734406 JOHN RAINE DRIVE
RAINELLEWV2596212/28/2011  
CH033080KROGER PHARMACY #765P. O BOX 13, RED OAKS SHOPPING CTR. 180 RED OAKS SHOPPING CTR.
RONCEVERTEWV2497004/01/2022  
CH033080M.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312610/01/2024 03/31/2025
CH033080NORTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02771 11911 US 70 BUS HWY WEST
CLAYTONNC2752004/01/2021  
CH033080OHIO CVS STORES, L.L.C.DBA: CVS/PHARMACY # 06270 404 AETNA ST.
MARTINS FERRYOH4393504/01/2021  
CH033080PILLPACK LLCDBA PILLPACK BY AMAZON PHARMACY 250 COMMERCIAL ST STE 2012
MANCHESTERNH0310104/01/2018 03/31/2025
CH033080PILLPACK LLCAMAZON PHARMACY #005 20416 72ND AVE S
KENTWA98032-231910/01/2024 03/31/2025
CH033080PRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100
ORLANDOFL32819-999204/01/2018 10/12/2022
CH033080PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/01/2022  
CH033080PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523307/01/2022  
CH033080PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULUHI9681307/01/2022  
CH033080PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920307/01/2022  
CH033080RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103
NEWBURGHNY1255004/01/2024  
CH033080RITE AID OF WEST VIRGINIA, INC.RITE AID #121 1250 KANAWHA AVENUE
RAINELLEWV2596207/01/2014 02/01/2018
CH033080RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500204/01/2024  
CH033080SANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301304/01/2024  
CH033080VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06326 1111 S. CRAIG AVE
COVINGTONVA2442601/01/2020  
CH033080VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06285 702 9TH ST. S.E.
ROANOKEVA2401307/01/2020  
CH033080VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06325 506 EAST NELSON STREET
LEXINGTONVA2445007/01/2020  
CH033080VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06321 1610 MAIN STREET
CLIFTON FORGEVA2442207/01/2020  
CH033080WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/01/2022  
CH033080WAL-MART PHARMACY 10-14991976 JEFFERSON STREET NORTH
LEWISBURGWV2490104/01/2022  
CH033080WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2022  
CH033080WALGREEN CO.WALGREENS #18404 1250 KANAWHA AVE
RAINELLEWV25962-712004/09/2018  
CH033080WALGREEN CO.WALGREENS #19961 198 POCAHONTAS TRL
WHITE SULPHUR SPRINGSWV24986-502507/01/2019 01/23/2025
CH033080WALGREEN CO.WALGREENS #17470 294 RED OAKS SHOPPING CTR
RONCEVERTEWV2497007/01/2019 11/09/2020
CH033080Walgreens #21420Walgreens Central Fill #21420 8440 Times Dispatch Blvd
Ste. 400
MechanicsvilleVA2311601/01/2024  
CH033080WALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700804/01/2018 10/01/2021
CH033080WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503304/01/2018  
CH033080WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527504/01/2018  
CH033080WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818804/01/2018  
CH033080WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A
ROGERSAR7275604/01/2023  
CH033080Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
CH033080WEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06333 9781 SENECA TRAIL S.
LEWISBURGWV2490101/01/2020  
CH033080WEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05946 72 WHITEWATER AVE.
FAYETTEVILLEWV2584001/01/2020  
CH033080WEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06313 159 BEAVER PLZ
BEAVERWV2581301/01/2020  
CH033080WEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04167 700 NORTHSIDE DR.
SUMMERSVILLEWV2665101/01/2020  
CH033080WEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07792 1827 HARPER ROAD
BECKLEYWV2580101/01/2020  
CH033080WEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY #6311 11078 MIDLAND TRL
GAULEY BRIDGEWV2508501/01/2020 04/03/2024
CH033080WEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06305 1414 N. EISENHOWER DR.
BECKLEYWV2580101/01/2020  
CH033080WEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06312 2811 ROBERT C. BYRD DR.
BECKLEYWV2580101/01/2020  
CH033080WEST VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04432 300 FOURTH AVE
MONTGOMERYWV2513607/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsStateUpdate To Be TerminatedTerminated4/1/2025 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 12/31/2024 12:00:00 AM1/23/2025 10:20 AM
DetailsStateUpdateTermination RequestActiveTo Be Terminated1/23/2025 10:20 AM
TerminationsTermination DateUpdateTermination Request 4/1/2025 12:00:00 AM1/23/2025 10:20 AM
TerminationsTermination Effective DateUpdateTermination Request 1/1/2025 12:00:00 AM1/23/2025 10:20 AM
TerminationsTermination ReasonUpdateTermination Request Site closure1/23/2025 10:20 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 191241495412/19/2024 11:34 AM
Medicaid BillingNPI: StateInsertGroup Change Request WV12/19/2024 11:34 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 191241495412/19/2024 11:34 AM
Medicaid BillingNPI: StateInsertGroup Change Request VA12/19/2024 11:34 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 149774641611/19/2024 10:39 AM
Medicaid BillingNPI: StateInsertGroup Change Request WV11/19/2024 10:39 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 138663471511/19/2024 10:39 AM
Medicaid BillingNPI: StateInsertGroup Change Request WV11/19/2024 10:39 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 149774641611/19/2024 10:39 AM
Medicaid BillingNPI: StateInsertGroup Change Request VA11/19/2024 10:39 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 138663471511/19/2024 10:39 AM
Medicaid BillingNPI: StateInsertGroup Change Request VA11/19/2024 10:39 AM
ContactsPrimary ContactUpdateProfile Change RequestYoakum, David R Pharmacy Director Rainelle Medical Center, Inc. 3044386188-1081Yoakum, David R Pharmacy Director Rainelle Medical Center, Inc. 3044386188-109910/1/2024 9:38 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1699871715 (WV) 9/11/2024 2:11 PM
Medicaid BillingNPI: NumberDeleteGroup Change Request1699871715 (VA) 9/11/2024 2:11 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 18016789259/11/2024 2:11 PM
Medicaid BillingNPI: StateInsertGroup Change Request WV9/11/2024 2:11 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 11541774269/11/2024 2:11 PM
Medicaid BillingNPI: StateInsertGroup Change Request WV9/11/2024 2:11 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 18016789259/11/2024 2:11 PM
Medicaid BillingNPI: StateInsertGroup Change Request VA9/11/2024 2:11 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 11541774269/11/2024 2:11 PM
Medicaid BillingNPI: StateInsertGroup Change Request VA9/11/2024 2:11 PM
Medicaid BillingNPI: NumberDeleteGroup Change Request1295398402 (WV) 7/9/2024 10:54 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1477221539 (WV) 7/9/2024 10:54 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1659675742 (WV) 7/9/2024 10:54 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1942567763 (WV) 7/9/2024 10:54 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1295398402 (VA) 7/9/2024 10:54 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1477221539 (VA) 7/9/2024 10:54 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1659675742 (VA) 7/9/2024 10:54 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1942567763 (VA) 7/9/2024 10:54 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16692123047/9/2024 10:54 AM
Medicaid BillingNPI: StateInsertGroup Change Request WV7/9/2024 10:54 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16692123047/9/2024 10:54 AM
Medicaid BillingNPI: StateInsertGroup Change Request VA7/9/2024 10:54 AM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False4/4/2024 1:19 PM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 12352381224/4/2024 1:19 PM
Medicaid BillingMedicaid: StateInsertGroup Change Request WV4/4/2024 1:19 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False4/4/2024 1:19 PM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 13366618344/4/2024 1:19 PM
Medicaid BillingMedicaid: StateInsertGroup Change Request WV4/4/2024 1:19 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 12352381223/20/2024 11:09 AM
Medicaid BillingNPI: StateInsertGroup Change Request WV3/20/2024 11:09 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 13366618343/20/2024 11:09 AM
Medicaid BillingNPI: StateInsertGroup Change Request WV3/20/2024 11:09 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/20/2024 10:47 AM
Medicaid BillingMedicaid: NumberInsertChange Request 14377722253/20/2024 10:47 AM
Medicaid BillingMedicaid: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 10034170233/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 10035724883/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 10838893233/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
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Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 11544240003/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 12058234653/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 12251355363/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 12354180053/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 12356221683/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 12657059093/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 12851282723/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 12953984023/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 13667481963/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 13768377573/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 14172004453/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 14677930913/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 14678411483/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 14772215393/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 14872985843/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 15189680313/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 16092566763/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 16596757423/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 16694368533/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 16694760573/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 16798202603/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 16997681503/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 16998717153/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 16999030213/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 17301722973/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 17706859923/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 18514071423/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 18814563903/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 19327279713/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 19425677633/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 19828254283/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertChange Request 19922506253/20/2024 10:47 AM
Medicaid BillingNPI: StateInsertChange Request VA3/20/2024 10:47 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 18814563903/19/2024 10:37 AM
Medicaid BillingNPI: StateInsertGroup Change Request WV3/19/2024 10:37 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19327279713/19/2024 10:37 AM
Medicaid BillingNPI: StateInsertGroup Change Request WV3/19/2024 10:37 AM
DetailsLast Recertification DateUpdateRecertification2/27/2023 7:13:43 AM2/1/2024 3:36:32 PM2/1/2024 3:36 PM
Medicaid BillingNPI: NumberInsertChange Request 16596757421/3/2024 1:01 PM
Medicaid BillingNPI: StateInsertChange Request WV1/3/2024 1:01 PM
Medicaid BillingNPI: NumberInsertChange Request 19425677631/3/2024 1:01 PM
Medicaid BillingNPI: StateInsertChange Request WV1/3/2024 1:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False11/30/2023 1:09 PM
Medicaid BillingMedicaid: NumberInsertChange Request 143777222511/30/2023 1:09 PM
Medicaid BillingMedicaid: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 122513553611/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 167982026011/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 160925667611/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 120582346511/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 173017229711/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 123562216811/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 129539840211/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 108388932311/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 199225062511/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 100341702311/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 166947605711/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 141720044511/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 115442400011/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 136674819611/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 137683775711/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 146779309111/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 185140714211/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 128512827211/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 169976815011/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 151896803111/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 109336820111/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 100357248811/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 198282542811/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 169987171511/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 148729858411/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 177068599211/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 166943685311/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 126570590911/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 147722153911/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 146784114811/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 169990302111/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
Medicaid BillingNPI: NumberInsertChange Request 123541800511/30/2023 1:09 PM
Medicaid BillingNPI: StateInsertChange Request WV11/30/2023 1:09 PM
AddressesMain AddressUpdateChange Request 289 Lewisburg, WV 24901 289 Dawkins Drive Lewisburg, WV 2490110/24/2023 11:41 AM
DetailsLast Recertification DateUpdateRecertification 2/27/2023 7:13:43 AM2/27/2023 7:13 AM
DetailsStateUpdate ApprovedActive1/1/2023 12:01 AM
ContactsSigned ByInsertNew Registration ATHA-RADER, KRISTI CEO Rainelle Medical Center, Inc. 3044386188-100610/4/2022 12:29 PM
Details340B IDUpdateNew Registration CH03308P10/4/2022 12:29 PM
DatesParticipating Approval DateUpdateNew Registration 10/4/2022 12:29:20 PM10/4/2022 12:29 PM
DetailsStateUpdateNew RegistrationPendingApproved10/4/2022 12:29 PM
DatesSigned By DateUpdateNew Registration 10/4/2022 12:13:58 PM10/4/2022 12:29 PM
DatesStart DateUpdateNew Registration 1/1/2023 12:00:00 AM10/4/2022 12:29 PM
AddressesMain AddressInsertNew Registration  289 Lewisburg, WV 2490110/4/2022 12:13 PM
AddressesBilling AddressInsertNew Registration Rainelle Medical Center 289 DAWKINS DR LEWISBURG, WV 2490110/4/2022 12:13 PM
ContactsAuthorizing OfficialInsertNew Registration ATHA-RADER, KRISTI CEO Rainelle Medical Center, Inc. 3044386188-100610/4/2022 12:13 PM
ContactsPrimary ContactInsertNew Registration Yoakum, David R Pharmacy Director Rainelle Medical Center, Inc. 3044386188-108110/4/2022 12:13 PM
DetailsAssistance Received From DateInsertNew Registration  10/4/2022 12:13 PM
DetailsAssistance Received To DateInsertNew Registration  10/4/2022 12:13 PM
DetailsLast Recertification DateInsertNew Registration  10/4/2022 12:13 PM
DetailsGrant NumberInsertNew Registration H80CS1827810/4/2022 12:13 PM
Details340B IDInsertNew Registration  10/4/2022 12:13 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  10/4/2022 12:13 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  10/4/2022 12:13 PM
DetailsMedicare Provider NumberInsertNew Registration  10/4/2022 12:13 PM
DetailsEntity NameInsertNew Registration RAINELLE MEDICAL CENTER10/4/2022 12:13 PM
DetailsNOFO NumberInsertNew Registration  10/4/2022 12:13 PM
DetailsProgram CodeInsertNew Registration CH10/4/2022 12:13 PM
DetailsEntity SubnameInsertNew Registration RMC Greenbrier Nephrology Center10/4/2022 12:13 PM
DatesParticipating Approval DateInsertNew Registration  10/4/2022 12:13 PM
DetailsStateInsertNew Registration Pending10/4/2022 12:13 PM
DatesRegistration DateInsertNew Registration 10/4/2022 12:13:55 PM10/4/2022 12:13 PM
DatesSigned By DateInsertNew Registration  10/4/2022 12:13 PM
DatesStart DateInsertNew Registration  10/4/2022 12:13 PM
TerminationsTermination CommentsInsertNew Registration  10/4/2022 12:13 PM
TerminationsTermination DateInsertNew Registration  10/4/2022 12:13 PM
TerminationsTermination Effective DateInsertNew Registration  10/4/2022 12:13 PM
TerminationsTermination ReasonInsertNew Registration  10/4/2022 12:13 PM