Covered Entity Details

CAH341315-07 Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital (Active) - information as of 4/27/2025 12:48:39 AM

Main Details

Name

Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital

Subdivision Name

CFV PRIMARY CARE-VINELAND FAMILY ME - Family Medicine

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH341315-07

Medicare Provider Number

341315

Outpatient Facility Provider Number

343477

Additional Details

Current Program Status

Active

Registration Date

4/13/2023

Participating Start Date

7/1/2023

Participating Approval Date

4/27/2023

Last Recertification Date

8/16/2024

Contacts

Authorizing Official

Bladen County Hospital
Spencer Lowell Cummings, President
(910) 862-5149

Primary Contact

Bladen Healthcare, LLC dba CFVHS-Bladen County Hospital
Karen Gentry, Pharmacy Director
(910) 862-5157

Addresses

Street Address

630 S MADISON ST
WHITEVILLE, NC 28472-4130

Billing Address

Bladen Healthcare, LLC
PO Box 398
Elizabethtown, NC 28337

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
NC	1558537282	1558537282

Shipping Addresses

Same as Street Address

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
CAH341315-01	Child	CAH	Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital	CAPE FEAR VALLEY BLADEN MEDICAL	16 3RD ST	DUBLIN	NC	Active
CAH341315-02	Child	CAH	Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital	CAPE FEAR VALLEY-BLADEN MEDICAL ASS	1106 W SEABOARD STREET	BLADENBORO	NC	Active
CAH341315-03	Child	CAH	Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital	CAPE FEAR VALLEY - BLADEN MEDICAL A	300 A EAST MCKAY STREET	ELIZABETHTOWN	NC	Active
CAH341315-04	Child	CAH	Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital	CAPE FEAR VALLEY-BLADEN MEDICAL EXP	107 EAST DUNHAM ST	ELIZABETHTOWN	NC	Active
CAH341315-05	Child	CAH	Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital	CFV BLADEN MEDICAL ASSOCIATES - Family medicine practice	9858 WR Lathan Drive	CLARKTON	NC	Active
CAH341315-06	Child	CAH	Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital	CFV BLADEN MEDICAL ASSOCIATES - BMA White Lake	273 WHITE LAKE DR	ELIZABETHTOWN	NC	Active
CAH341315-07	Child	CAH	Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital	CFV PRIMARY CARE-VINELAND FAMILY ME - Family Medicine	630 S MADISON ST	WHITEVILLE	NC	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 9:25:59 AM	8/16/2024 2:54:03 PM	8/16/2024 2:54 PM
Contacts	Authorizing Official	Update	AO Change Request	Fife, Stephen President & CFO Bladen Healthcare, LLC 9108625149	Cummings, Spencer Lowell President Bladen County Hospital 9108625149	10/12/2023 11:35 AM
Details	Last Recertification Date	Update	Recertification		8/15/2023 9:25:59 AM	8/15/2023 9:25 AM
Details	State	Update		Approved	Active	7/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Fife, Stephen President & CFO Bladen Healthcare, LLC 9108625149	4/27/2023 7:25 AM
Details	340B ID	Update	New Registration		CAH341315-07	4/27/2023 7:25 AM
Details	Entity Name	Update	New Registration	BLADEN COUNTY HOSPITAL	Bladen Healthcare, LLC DBA Cape Fear Valley Health System - Bladen County Hospital	4/27/2023 7:25 AM
Details	Entity Subname	Update	New Registration	CFV PRIMARY CARE-VINELAND FAMILY ME	CFV PRIMARY CARE-VINELAND FAMILY ME - Family Medicine	4/27/2023 7:25 AM
Dates	Participating Approval Date	Update	New Registration		4/27/2023 7:25:36 AM	4/27/2023 7:25 AM
Details	State	Update	New Registration	Pending	Approved	4/27/2023 7:25 AM
Dates	Signed By Date	Update	New Registration		4/25/2023 1:33:40 PM	4/27/2023 7:25 AM
Dates	Start Date	Update	New Registration		7/1/2023 12:00:00 AM	4/27/2023 7:25 AM
Addresses	Main Address	Insert	New Registration		630 S MADISON ST WHITEVILLE, NC 28472-4130	4/13/2023 2:49 PM
Addresses	Billing Address	Insert	New Registration		Bladen Healthcare, LLC PO Box 398 Elizabethtown, NC 28337	4/13/2023 2:49 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/13/2023 2:49 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1558537282	4/13/2023 2:49 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NC	4/13/2023 2:49 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1558537282	4/13/2023 2:49 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	4/13/2023 2:49 PM
Contacts	Primary Contact	Insert	New Registration		Gentry, Karen Pharmacy Director Bladen Healthcare, LLC dba CFVHS-Bladen County Hospital 9108625157	4/13/2023 2:49 PM
Contacts	Authorizing Official	Insert	New Registration		Fife, Stephen President & CFO Bladen Healthcare, LLC 9108625149	4/13/2023 2:49 PM
Details	Assistance Received From Date	Insert	New Registration			4/13/2023 2:49 PM
Details	Assistance Received To Date	Insert	New Registration			4/13/2023 2:49 PM
Details	Last Recertification Date	Insert	New Registration			4/13/2023 2:49 PM
Details	Grant Number	Insert	New Registration			4/13/2023 2:49 PM
Details	340B ID	Insert	New Registration			4/13/2023 2:49 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/13/2023 2:49 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/13/2023 2:49 PM
Details	Medicare Provider Number	Insert	New Registration		341315	4/13/2023 2:49 PM
Details	Entity Name	Insert	New Registration		BLADEN COUNTY HOSPITAL	4/13/2023 2:49 PM
Details	NOFO Number	Insert	New Registration			4/13/2023 2:49 PM
Details	Program Code	Insert	New Registration		CAH	4/13/2023 2:49 PM
Details	Entity Subname	Insert	New Registration		CFV PRIMARY CARE-VINELAND FAMILY ME	4/13/2023 2:49 PM
Dates	Participating Approval Date	Insert	New Registration			4/13/2023 2:49 PM
Details	State	Insert	New Registration		Pending	4/13/2023 2:49 PM
Dates	Registration Date	Insert	New Registration		4/13/2023 2:49:32 PM	4/13/2023 2:49 PM
Dates	Signed By Date	Insert	New Registration			4/13/2023 2:49 PM
Dates	Start Date	Insert	New Registration			4/13/2023 2:49 PM
Terminations	Termination Comments	Insert	New Registration			4/13/2023 2:49 PM
Terminations	Termination Date	Insert	New Registration			4/13/2023 2:49 PM
Terminations	Termination Effective Date	Insert	New Registration			4/13/2023 2:49 PM
Terminations	Termination Reason	Insert	New Registration			4/13/2023 2:49 PM