Covered Entity Details

DSH510046C PRINCETON COMMUNITY HOSPITAL (Active) - information as of 4/25/2025 8:36:57 PM

Main Details

Name

PRINCETON COMMUNITY HOSPITAL

Subdivision Name

PCH BLUEFIELD ED - Emergency Department

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH510046C

Medicare Provider Number

510046

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/10/2023

Participating Start Date

1/1/2024

Participating Approval Date

11/7/2023

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

Princeton Community Hospital Association, Inc.
Diane Lynn Spencer, VP of Finance/CFO
(304) 487-7505

Primary Contact

Princeton Community Hospital
Daniel Paul Morrison, Director of Pharmacy
(304) 487-7564

Addresses

Street Address

500 CHERRY ST
STE A
BLUEFIELD, WV 24701-3306

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
WV		1558313213,1619053329,1972610863,1972810125,1063729218
VA		1558313213,1619053329,1972610863,1972810125,1063729218
OH		1558313213,1619053329,1972610863,1972810125,1063729218
PA		1558313213,1619053329,1972610863,1972810125,1063729218
KY		1558313213,1619053329,1972610863,1972810125,1063729218

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
DSH510046A	Child	DSH	PRINCETON COMMUNITY HOSPITAL	BEHAVIORAL HEALTH PAVILION-OUTPATIENT TREATMENT	1333 SOUTHVIEW DRIVE	BLUEFIELD	WV	Active
DSH510046B	Child	DSH	PRINCETON COMMUNITY HOSPITAL	PRINCETON COMMUNITY HOSPITAL - Rural Health Clinic 2	401 E VERMILLION ST	ATHENS	WV	Active
DSH510046C	Child	DSH	PRINCETON COMMUNITY HOSPITAL	PCH BLUEFIELD ED - Emergency Department	500 CHERRY ST	BLUEFIELD	WV	Active
DSH510046D	Child	DSH	PRINCETON COMMUNITY HOSPITAL	WVU Cancer Institute PCH Cancer Medicine - Hematology/Oncology	122 Twelfth Street	Princeton	WV	Terminated
DSH510046E	Child	DSH	PRINCETON COMMUNITY HOSPITAL	PRINCETON COMMUNITY HOSPITAL ASSOC. - Bluefield Internal Medicine	510 CHERRY ST	BLUEFIELD	WV	Active
DSH510046F	Child	DSH	PRINCETON COMMUNITY HOSPITAL	Bluefield Family Medicine - Bluefield Family Medicine	106 Huffard Drive	Bluefield	VA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
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	10/22/2024 9:11 AM
Details	Last Recertification Date	Update	Recertification		8/14/2024 3:09:05 PM	8/14/2024 3:09 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	010065000 (MD)		6/7/2024 2:02 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1558313213 (MD)		6/7/2024 2:02 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1558313213 (SC)		6/7/2024 2:02 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1558313213 (TN)		6/7/2024 2:02 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1558313213 (NC)		6/7/2024 2:02 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	0001110000 (WV)		6/5/2024 11:11 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	005100461 (VA)		6/5/2024 11:11 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	0233590 (OH)		6/5/2024 11:11 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000820535-0001 (PA)		6/5/2024 11:11 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	12010B (SC)		6/5/2024 11:11 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	0510046 (TN)		6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1619053329	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972610863	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972810125	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1063729218	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		WV	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1619053329	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972610863	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972810125	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1063729218	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		OH	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1619053329	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972610863	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972810125	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1063729218	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1619053329	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972610863	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972810125	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1063729218	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1558313213	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1619053329	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972610863	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1972810125	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	6/5/2024 11:11 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1063729218	6/5/2024 11:11 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	6/5/2024 11:11 AM
Details	State	Update		Approved	Active	1/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Spencer, Diane Lynn VP of Finance/CFO Princeton Community Hospital Association, Inc. 3044877505	11/7/2023 10:43 AM
Details	340B ID	Update	New Registration		DSH510046C	11/7/2023 10:43 AM
Details	Entity Subname	Update	New Registration	PCH BLUEFIELD ED	PCH BLUEFIELD ED - Emergency Department	11/7/2023 10:43 AM
Dates	Participating Approval Date	Update	New Registration		11/7/2023 10:43:45 AM	11/7/2023 10:43 AM
Details	State	Update	New Registration	Pending	Approved	11/7/2023 10:43 AM
Dates	Signed By Date	Update	New Registration		10/10/2023 2:12:16 PM	11/7/2023 10:43 AM
Dates	Start Date	Update	New Registration		1/1/2024 12:00:00 AM	11/7/2023 10:43 AM
Addresses	Main Address	Insert	New Registration		500 CHERRY ST STE A BLUEFIELD, WV 24701-3306	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0001110000	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		WV	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		005100461	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		VA	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		010065000	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MD	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0233590	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OH	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		000820535-0001	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		12010B	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		SC	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0510046	10/10/2023 12:21 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TN	10/10/2023 12:21 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1558313213	10/10/2023 12:21 PM
Medicaid Billing	NPI: State	Insert	New Registration		WV	10/10/2023 12:21 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1558313213	10/10/2023 12:21 PM
Medicaid Billing	NPI: State	Insert	New Registration		VA	10/10/2023 12:21 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1558313213	10/10/2023 12:21 PM
Medicaid Billing	NPI: State	Insert	New Registration		MD	10/10/2023 12:21 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1558313213	10/10/2023 12:21 PM
Medicaid Billing	NPI: State	Insert	New Registration		OH	10/10/2023 12:21 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1558313213	10/10/2023 12:21 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/10/2023 12:21 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1558313213	10/10/2023 12:21 PM
Medicaid Billing	NPI: State	Insert	New Registration		SC	10/10/2023 12:21 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1558313213	10/10/2023 12:21 PM
Medicaid Billing	NPI: State	Insert	New Registration		TN	10/10/2023 12:21 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1558313213	10/10/2023 12:21 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	10/10/2023 12:21 PM
Contacts	Authorizing Official	Insert	New Registration		Spencer, Diane Lynn VP of Finance/CFO Princeton Community Hospital Association, Inc. 3044877505	10/10/2023 12:21 PM
Contacts	Primary Contact	Insert	New Registration		Morrison, Daniel Paul Director of Pharmacy Princeton Community Hospital 3044877564	10/10/2023 12:21 PM
Details	Assistance Received From Date	Insert	New Registration			10/10/2023 12:21 PM
Details	Assistance Received To Date	Insert	New Registration			10/10/2023 12:21 PM
Details	Last Recertification Date	Insert	New Registration			10/10/2023 12:21 PM
Details	Grant Number	Insert	New Registration			10/10/2023 12:21 PM
Details	340B ID	Insert	New Registration			10/10/2023 12:21 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/10/2023 12:21 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/10/2023 12:21 PM
Details	Medicare Provider Number	Insert	New Registration		510046	10/10/2023 12:21 PM
Details	Entity Name	Insert	New Registration		PRINCETON COMMUNITY HOSPITAL	10/10/2023 12:21 PM
Details	NOFO Number	Insert	New Registration			10/10/2023 12:21 PM
Details	Program Code	Insert	New Registration		DSH	10/10/2023 12:21 PM
Details	Entity Subname	Insert	New Registration		PCH BLUEFIELD ED	10/10/2023 12:21 PM
Dates	Participating Approval Date	Insert	New Registration			10/10/2023 12:21 PM
Details	State	Insert	New Registration		Pending	10/10/2023 12:21 PM
Dates	Registration Date	Insert	New Registration		10/10/2023 12:21:15 PM	10/10/2023 12:21 PM
Dates	Signed By Date	Insert	New Registration			10/10/2023 12:21 PM
Dates	Start Date	Insert	New Registration			10/10/2023 12:21 PM
Terminations	Termination Comments	Insert	New Registration			10/10/2023 12:21 PM
Terminations	Termination Date	Insert	New Registration			10/10/2023 12:21 PM
Terminations	Termination Effective Date	Insert	New Registration			10/10/2023 12:21 PM
Terminations	Termination Reason	Insert	New Registration			10/10/2023 12:21 PM