Covered Entity Details

DSH490021K CENTRA HEALTH (Active) - information as of 4/25/2025 8:33:09 PM

Main Details

Name

CENTRA HEALTH

Subdivision Name

VBH/CT Scan - CT Scan

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH490021K

Medicare Provider Number

490021

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/14/2023

Participating Start Date

10/1/2023

Participating Approval Date

9/12/2023

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Centra Health, Inc.
James A. Frenchik, President Centra Health Lynchburg Region
(434) 200-3014

Primary Contact

Centra Health Inc
Cynthia W. Mann, Pharmacy Purchasing Manager
(434) 200-7297

Addresses

Street Address

3300 Rivermont Ave
Lynchburg, VA 24503

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
VA	4900219	1770693939

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
DSH490021A	Child	DSH	CENTRA HEALTH	VBH/ Ultrasound - Ultrasound	3300 Rivermont Ave	Lynchburg	VA	Active
DSH490021B	Child	DSH	CENTRA HEALTH	VBH/ Outpatient Department - Infusion	3300 Rivermont Avenue	Lynchburg	VA	Active
DSH490021C	Child	DSH	CENTRA HEALTH	Alan B Pearson Regional Cancer Center Nuclear Medicine - PET/CT - PET/CT	1701 Thomson Drive	Lynchburg	VA	Active
DSH490021D	Child	DSH	CENTRA HEALTH	VBH/Anesthesia - Anesthesia	3300 Rivermont Ave	Lynchburg	VA	Active
DSH490021E	Child	DSH	CENTRA HEALTH	Alan B Pearson Regional Cancer Center/ Radiation Oncology - Radiation Oncology	1701 Thomson Drive	Lynchburg	VA	Active
DSH490021F	Child	DSH	CENTRA HEALTH	Gretna Medical Center / Emergency Dept - Emergency Dept	291 McBride Lane	Gretna	VA	Active
DSH490021G	Child	DSH	CENTRA HEALTH	Wound Care - Wound Care	2410 Atherholt Road	Lynchburg	VA	Active
DSH490021H	Child	DSH	CENTRA HEALTH	VBH/ Recovery Room - Recovery Room	3300 Rivermont Ave	Lynchburg	VA	Active
DSH490021J	Child	DSH	CENTRA HEALTH	VBH/ Endoscopy - Endoscopy	3300 Rivermont Ave	Lynchburg	VA	Active
DSH490021K	Child	DSH	CENTRA HEALTH	VBH/CT Scan - CT Scan	3300 Rivermont Ave	Lynchburg	VA	Active
DSH490021L	Child	DSH	CENTRA HEALTH	VBH/ Radiology - Radiology	3300 Rivermont Ave	Lynchburg	VA	Active
DSH490021M	Child	DSH	CENTRA HEALTH	VBH/ Birth Ctr - Labor and Delivery	3300 Rivermont Ave	Lynchburg	VA	Active
DSH490021N	Child	DSH	CENTRA HEALTH	VBH/Respiratory Therapy - Respiratory Therapy	3300 Rivermont Ave	Lynchburg	VA	Active
DSH490021P	Child	DSH	CENTRA HEALTH	VBH/ Ambulatory Surgery - Ambulatory Surgery	3300 Rivermont Ave	Lynchburg	VA	Active
DSH490021Q	Child	DSH	CENTRA HEALTH	Stroobants Cardiovascular Center - Cardiology	2410 Atherholt Road	Lynchburg	VA	Active
DSH490021R	Child	DSH	CENTRA HEALTH	VBH/ OR - OR	3300 Rivermont Ave	Lynchburg	VA	Active
DSH490021S	Child	DSH	CENTRA HEALTH	Pain Management Center - Pain Management	1330 Oak Lane, Suite 202	Lynchburg	VA	Active
DSH490021T	Child	DSH	CENTRA HEALTH	VBH/Nuclear Med - Nuclear Medicine	3300 Rivermont Ave	Lynchburg	VA	Active
DSH490021U	Child	DSH	CENTRA HEALTH	Alan B. Pearson Regional Cancer Center/ Oncology Hematology Clinic - Oncology Hematology Clinic	1701 Thomson Drive	Lynchburg	VA	Active
DSH490021V	Child	DSH	CENTRA HEALTH	Virginia Baptist - Observation - VBH / Adult & Ped Observation	3300 Rivermont Ave	Lynchburg	VA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Culbertson, Tabitha M. President, Lynchburg General &Virginia Baptist Hospitals Centra Health Inc. 4342003014	Frenchik, James A. President Centra Health Lynchburg Region Centra Health, Inc. 4342003014	3/14/2025 9:38 AM
Details	Last Recertification Date	Update	Recertification		8/15/2024 10:17:12 AM	8/15/2024 10:17 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/11/2023 10:07 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		4900219	12/11/2023 10:07 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		VA	12/11/2023 10:07 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1770693939	12/11/2023 10:07 AM
Medicaid Billing	NPI: State	Insert	Change Request		VA	12/11/2023 10:07 AM
Details	State	Update		Approved	Active	10/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Culbertson, Tabitha M. President, Lynchburg General &Virginia Baptist Hospitals Centra Health Inc. 4342003014	9/12/2023 11:02 PM
Details	340B ID	Update	New Registration		DSH490021K	9/12/2023 11:02 PM
Details	Entity Subname	Update	New Registration	VBH/CT Scan	VBH/CT Scan - CT Scan	9/12/2023 11:02 PM
Dates	Participating Approval Date	Update	New Registration		9/12/2023 11:02:57 PM	9/12/2023 11:02 PM
Details	State	Update	New Registration	Pending	Approved	9/12/2023 11:02 PM
Dates	Signed By Date	Update	New Registration		9/12/2023 10:50:24 AM	9/12/2023 11:02 PM
Dates	Start Date	Update	New Registration		10/1/2023 12:00:00 AM	9/12/2023 11:02 PM
Contacts	Authorizing Official	Update	Profile Change Request	Culbertson, Tabitha M. VP OPERATIONS & HOSPITAL ADMINISTRATION Centra Health Inc. 4342003014	Culbertson, Tabitha M. President, Lynchburg General &Virginia Baptist Hospitals Centra Health Inc. 4342003014	7/24/2023 2:47 PM
Addresses	Main Address	Insert	New Registration		3300 Rivermont Ave Lynchburg, VA 24503	7/14/2023 4:31 PM
Contacts	Authorizing Official	Insert	New Registration		Culbertson, Tabitha M. VP OPERATIONS & HOSPITAL ADMINISTRATION Centra Health Inc. 4342003014	7/14/2023 4:31 PM
Contacts	Primary Contact	Insert	New Registration		Mann, Cynthia W. Pharmacy Purchasing Manager Centra Health Inc 4342007297	7/14/2023 4:31 PM
Details	Assistance Received From Date	Insert	New Registration			7/14/2023 4:31 PM
Details	Assistance Received To Date	Insert	New Registration			7/14/2023 4:31 PM
Details	Last Recertification Date	Insert	New Registration			7/14/2023 4:31 PM
Details	Grant Number	Insert	New Registration			7/14/2023 4:31 PM
Details	340B ID	Insert	New Registration			7/14/2023 4:31 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/14/2023 4:31 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/14/2023 4:31 PM
Details	Medicare Provider Number	Insert	New Registration		490021	7/14/2023 4:31 PM
Details	Entity Name	Insert	New Registration		CENTRA HEALTH	7/14/2023 4:31 PM
Details	NOFO Number	Insert	New Registration			7/14/2023 4:31 PM
Details	Program Code	Insert	New Registration		DSH	7/14/2023 4:31 PM
Details	Entity Subname	Insert	New Registration		VBH/CT Scan	7/14/2023 4:31 PM
Dates	Participating Approval Date	Insert	New Registration			7/14/2023 4:31 PM
Details	State	Insert	New Registration		Pending	7/14/2023 4:31 PM
Dates	Registration Date	Insert	New Registration		7/14/2023 4:31:12 PM	7/14/2023 4:31 PM
Dates	Signed By Date	Insert	New Registration			7/14/2023 4:31 PM
Dates	Start Date	Insert	New Registration			7/14/2023 4:31 PM
Terminations	Termination Comments	Insert	New Registration			7/14/2023 4:31 PM
Terminations	Termination Date	Insert	New Registration			7/14/2023 4:31 PM
Terminations	Termination Effective Date	Insert	New Registration			7/14/2023 4:31 PM
Terminations	Termination Reason	Insert	New Registration			7/14/2023 4:31 PM