Covered Entity Details

DSH490021E CENTRA HEALTH (ToBeTerminated) - information as of 5/24/2025 10:35:37 PM

Main Details

Name

CENTRA HEALTH

Subdivision Name

Alan B Pearson Regional Cancer Center/ Radiation Oncology - Radiation Oncology

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH490021E

Medicare Provider Number

490021

Outpatient Facility Provider Number

Additional Details

Current Program Status

ToBeTerminated

Registration Date

7/17/2023

Participating Start Date

10/1/2023

Participating Approval Date

9/12/2023

Last Recertification Date

8/15/2024

Termination Date
Termination Reason

7/1/2025
Change of covered entity type

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

1701 Thomson Drive
Lynchburg, VA 24501

Billing Address

Centra Health Inc.
1901 Tate Springs Road
Lynchburg, VA 24501

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

Shipping Address 1

Centra Health Inc.
1901 Tate Springs Road
Lynchburg, VA 24501

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

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		7/1/2025 12:00:00 AM	5/8/2025 8:42 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	5/8/2025 8:42 AM
Terminations	Termination Date	Update	Hospital Type Change Request		7/1/2025 12:00:00 AM	5/8/2025 8:42 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		7/1/2025 12:00:00 AM	5/8/2025 8:42 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	5/8/2025 8:42 AM
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 10:17:00 AM	8/15/2024 10:17 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/5/2024 5:56 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		4900219	3/5/2024 5:56 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		VA	3/5/2024 5:56 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1770693939	3/5/2024 5:56 PM
Medicaid Billing	NPI: State	Insert	Change Request		VA	3/5/2024 5:56 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	4900219 (VA)		12/13/2023 9:52 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1770693939 (VA)		12/13/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/11/2023 10:13 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		4900219	12/11/2023 10:13 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		VA	12/11/2023 10:13 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1770693939	12/11/2023 10:13 AM
Medicaid Billing	NPI: State	Insert	Change Request		VA	12/11/2023 10:13 AM
Details	State	Update		Approved	Active	10/1/2023 12:01 AM
Addresses	Main Address	Insert	New Registration		1701 Thomson Drive Lynchburg, VA 24501	9/12/2023 10:56 PM
Addresses	Billing Address	Insert	New Registration		Centra Health Inc. 1901 Tate Springs Road Lynchburg, VA 24501	9/12/2023 10:56 PM
Addresses	Shipping Address	Insert	New Registration		Centra Health Inc. 1901 Tate Springs Road Lynchburg, VA 24501	9/12/2023 10:56 PM
Contacts	Signed By	Insert	New Registration		Culbertson, Tabitha M. President, Lynchburg General &Virginia Baptist Hospitals Centra Health Inc. 4342003014	9/12/2023 10:56 PM
Details	340B ID	Update	New Registration		DSH490021E	9/12/2023 10:56 PM
Details	Entity Subname	Update	New Registration	Alan B Pearson Regional Cancer Center/ Radiation Oncology	Alan B Pearson Regional Cancer Center/ Radiation Oncology - Radiation Oncology	9/12/2023 10:56 PM
Dates	Participating Approval Date	Update	New Registration		9/12/2023 10:56:21 PM	9/12/2023 10:56 PM
Details	State	Update	New Registration	Pending	Approved	9/12/2023 10:56 PM
Dates	Signed By Date	Update	New Registration		9/12/2023 10:47:40 AM	9/12/2023 10:56 PM
Dates	Start Date	Update	New Registration		10/1/2023 12:00:00 AM	9/12/2023 10:56 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		1701 Thomson Drive Lynchburg, VA 24501	7/17/2023 11:05 AM
Addresses	Billing Address	Insert	New Registration		Centra Health Inc. 1901 Tate Springs Road Lynchburg, VA 24501	7/17/2023 11:05 AM
Contacts	Authorizing Official	Insert	New Registration		Culbertson, Tabitha M. VP OPERATIONS & HOSPITAL ADMINISTRATION Centra Health Inc. 4342003014	7/17/2023 11:05 AM
Contacts	Primary Contact	Insert	New Registration		Mann, Cynthia W. Pharmacy Purchasing Manager Centra Health Inc 4342007297	7/17/2023 11:05 AM
Details	Assistance Received From Date	Insert	New Registration			7/17/2023 11:05 AM
Details	Assistance Received To Date	Insert	New Registration			7/17/2023 11:05 AM
Details	Last Recertification Date	Insert	New Registration			7/17/2023 11:05 AM
Details	Grant Number	Insert	New Registration			7/17/2023 11:05 AM
Details	340B ID	Insert	New Registration			7/17/2023 11:05 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/17/2023 11:05 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/17/2023 11:05 AM
Details	Medicare Provider Number	Insert	New Registration		490021	7/17/2023 11:05 AM
Details	Entity Name	Insert	New Registration		CENTRA HEALTH	7/17/2023 11:05 AM
Details	NOFO Number	Insert	New Registration			7/17/2023 11:05 AM
Details	Program Code	Insert	New Registration		DSH	7/17/2023 11:05 AM
Details	Entity Subname	Insert	New Registration		Alan B Pearson Regional Cancer Center/ Radiation Oncology	7/17/2023 11:05 AM
Dates	Participating Approval Date	Insert	New Registration			7/17/2023 11:05 AM
Details	State	Insert	New Registration		Pending	7/17/2023 11:05 AM
Dates	Registration Date	Insert	New Registration		7/17/2023 11:05:47 AM	7/17/2023 11:05 AM
Dates	Signed By Date	Insert	New Registration			7/17/2023 11:05 AM
Dates	Start Date	Insert	New Registration			7/17/2023 11:05 AM
Terminations	Termination Comments	Insert	New Registration			7/17/2023 11:05 AM
Terminations	Termination Date	Insert	New Registration			7/17/2023 11:05 AM
Terminations	Termination Effective Date	Insert	New Registration			7/17/2023 11:05 AM
Terminations	Termination Reason	Insert	New Registration			7/17/2023 11:05 AM