Covered Entity Details

DSH510007BB ST. MARYS MEDICAL CENTER INC. (Active) - information as of 5/20/2025 11:43:06 PM

Main Details

Name

ST. MARYS MEDICAL CENTER INC.

Subdivision Name

HIMG - Perioperative Clinic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH510007BB

Medicare Provider Number

510007

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/3/2024

Participating Start Date

4/1/2024

Participating Approval Date

2/9/2024

Last Recertification Date

8/26/2024

Contacts

Authorizing Official

St. Mary's Medical Center
Aaron C Blevins, Chief Pharmacy Officer
(304) 526-8250

Primary Contact

St. Mary's Medical Center
Kathy Walker, 340B Program Coordinator
(304) 526-8748

Addresses

Street Address

3075 US Route 60
STE B420
Huntington, WV 25705-8859

Billing Address

St. Mary's Medical Center Inc.
2900 First Avenue
Huntington, WV 25702-1241

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?
No

Shipping Addresses

Shipping Address 1

St. Mary's Medical Center HIMG Campus
3075 US Route 60
Huntington, WV 25705-8859

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
DSH510007A	Child	DSH	ST. MARYS MEDICAL CENTER INC.	Ironton / Radiology	1408 Campbell Drive	Ironton	OH	Active
DSH510007AA	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG NEUROLOGY	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007AB	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG ONCOLOGY	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007AC	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG OPHTHALMOLOGY	5170 US60 E	HUNTINGTON	WV	Terminated
DSH510007AD	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG OPTOMETRY	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007AE	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG PAIN MANAGEMENT - Pain Management	5170 US60 E	HUNTINGTON	WV	Terminated
DSH510007AF	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG UROLOGY	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007AG	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG SURGERY	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007AH	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG NOW CARE	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007AJ	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG PRIMARY CARE	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007AK	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG PODIATRY	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007AL	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG PULMONARY	5170 US60 E	HUNTINGTON	WV	Active
DSH510007AM	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG RHEUMATOLOGY	3075 US Route 60	HUNTINGTON	WV	Terminated
DSH510007AN	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG WOMEN'S HEALTH	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007AP	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG CT SCAN	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007AQ	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG DIAGNOSTIC X-RAY	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007AR	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG ECHOCARDIOGRAM	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007AS	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG NUCLEAR MED	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007AT	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG MAMMOGRAPHY	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007AU	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG ULTRASOUND	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007AV	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG VASCULAR US	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007AW	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG MRI	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007AX	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG LABORATORY	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007AY	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG ENDOSCOPY	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007AZ	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG Infusion Center	3075 US Route 60	Huntington	WV	Active
DSH510007B	Child	DSH	ST. MARYS MEDICAL CENTER INC.	IRONTON / CT	1408 Campbell Drive	Ironton	OH	Active
DSH510007BA	Child	DSH	ST. MARYS MEDICAL CENTER INC.	Neurophysiology Lab	2801 South Staunton Avenue	Huntington	WV	Active
DSH510007BB	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG - Perioperative Clinic	3075 US Route 60	Huntington	WV	Active
DSH510007BC	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG Pain Management - Orthopedics	3075 US Route 60	HUNTINGTON	WV	Terminated
DSH510007BD	Child	DSH	ST. MARYS MEDICAL CENTER INC.	Hurricane - Family Care	147 Willow Tree Way	Hurricane	WV	Active
DSH510007BE	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG - Orthopedic OP	3075 US Route 60	Huntington	WV	Active
DSH510007C	Child	DSH	ST. MARYS MEDICAL CENTER INC.	Ironton / MRI	1408 Campbell Drive	Ironton	OH	Terminated
DSH510007D	Child	DSH	ST. MARYS MEDICAL CENTER INC.	IRONTON / Lab	1408 Campbell Drive	Ironton	OH	Active
DSH510007E	Child	DSH	ST. MARYS MEDICAL CENTER INC.	Ironton / Emergency Department	1408 Campbell Drive	Ironton	OH	Active
DSH510007F	Child	DSH	ST. MARYS MEDICAL CENTER INC.	Clinic	2828 First Avenue, Suite 100	Huntington	WV	Active
DSH510007G	Child	DSH	ST. MARYS MEDICAL CENTER INC.	St. Mary's Occupational Medicine	2833 Fifth Ave	Huntington	WV	Terminated
DSH510007H	Child	DSH	ST. MARYS MEDICAL CENTER INC.	St. Mary's Urgent Care and Occupational Medicine	2827 Fifth Ave	Huntington	WV	Active
DSH510007J	Child	DSH	ST. MARYS MEDICAL CENTER INC.	St. Mary's Infectious Disease	2828 First Avenue, Suite 304	Huntington	WV	Terminated
DSH510007K	Child	DSH	ST. MARYS MEDICAL CENTER INC.	St Mary's Surgery	2828 First Avenue, Suite 205	Huntington	WV	Active
DSH510007L	Child	DSH	ST. MARYS MEDICAL CENTER INC.	St. Mary's Cardiac Electrophysiology	2828 First Avenue	Huntington	WV	Active
DSH510007M	Child	DSH	ST. MARYS MEDICAL CENTER INC.	St. Mary's Cardiovascular & Thoracic Surgery	2828 1st Ave	Huntington	WV	Active
DSH510007N	Child	DSH	ST. MARYS MEDICAL CENTER INC.	St. Mary's Pediatrics	2828 First Avenue, Suite 305	Huntington	WV	Terminated
DSH510007P	Child	DSH	ST. MARYS MEDICAL CENTER INC.	St. Mary's Family Care - Highlawn	2833 5th Ave	Huntington	WV	Terminated
DSH510007Q	Child	DSH	ST. MARYS MEDICAL CENTER INC.	St. Mary's Family Care Barboursville	One Chateau Lane	Barboursville	WV	Terminated
DSH510007R	Child	DSH	ST. MARYS MEDICAL CENTER INC.	St. Mary's Women and Family Care	143 Peyton Street	Barboursville	WV	Active
DSH510007S	Child	DSH	ST. MARYS MEDICAL CENTER INC.	ST. MARY'S NEUROLOGY	2900 FIRST AVENUE	HUNTINGTON	WV	Terminated
DSH510007T	Child	DSH	ST. MARYS MEDICAL CENTER INC.	ST MARY'S NEUROSURGERY	2900 FIRST AVENUE	HUNTINGTON	WV	Active
DSH510007U	Child	DSH	ST. MARYS MEDICAL CENTER INC.	ST MARY'S UROLOGY	2900 FIRST AVENUE	HUNTINGTON	WV	Active
DSH510007V	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG CARDIOLOGY	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007W	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG DERMATOLOGY	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007X	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG ELECTROPHYSIOLOGY	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007Y	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG GASTROENTEROLOGY	3075 US Route 60	HUNTINGTON	WV	Active
DSH510007Z	Child	DSH	ST. MARYS MEDICAL CENTER INC.	HIMG NEPHROLOGY	3075 US Route 60	HUNTINGTON	WV	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Billing Address	Update	Recertification	St. Mary's Medical Center Inc. 2900 First Avenue Huntington, WV 25702	St. Mary's Medical Center Inc. 2900 First Avenue Huntington, WV 25702-1241	8/26/2024 7:58 AM
Details	Last Recertification Date	Update	Recertification		8/26/2024 7:58:40 AM	8/26/2024 7:58 AM
Addresses	Main Address	Update	Change Request	5170 US60 E STE 420 Huntington, WV 25705	3075 US Route 60 STE B420 Huntington, WV 25705-8859	6/17/2024 1:01 PM
Addresses	Shipping Address	Update	Change Request	St. Mary's Medical Center HIMG Campus 5170 US Route 60 Huntington, WV 25705	St. Mary's Medical Center HIMG Campus 3075 US Route 60 Huntington, WV 25705-8859	6/17/2024 1:01 PM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Blevins, Aaron C Chief Pharmacy Officer St. Mary's Medical Center 3045268250	2/9/2024 8:08 AM
Details	340B ID	Update	New Registration		DSH510007BB	2/9/2024 8:08 AM
Details	Entity Subname	Update	New Registration	HIMG	HIMG - Perioperative Clinic	2/9/2024 8:08 AM
Dates	Participating Approval Date	Update	New Registration		2/9/2024 8:08:38 AM	2/9/2024 8:08 AM
Details	State	Update	New Registration	Pending	Approved	2/9/2024 8:08 AM
Dates	Signed By Date	Update	New Registration		1/11/2024 2:29:41 PM	2/9/2024 8:08 AM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	2/9/2024 8:08 AM
Addresses	Main Address	Insert	New Registration		5170 US60 E STE 420 Huntington, WV 25705	1/3/2024 12:20 PM
Addresses	Billing Address	Insert	New Registration		St. Mary's Medical Center Inc. 2900 First Avenue Huntington, WV 25702	1/3/2024 12:20 PM
Addresses	Shipping Address	Insert	New Registration		St. Mary's Medical Center HIMG Campus 5170 US Route 60 Huntington, WV 25705	1/3/2024 12:20 PM
Contacts	Authorizing Official	Insert	New Registration		Blevins, Aaron C Chief Pharmacy Officer St. Mary's Medical Center 3045268250	1/3/2024 12:20 PM
Contacts	Primary Contact	Insert	New Registration		Walker, Kathy 340B Program Coordinator St. Mary's Medical Center 3045268748	1/3/2024 12:20 PM
Details	Assistance Received From Date	Insert	New Registration			1/3/2024 12:20 PM
Details	Assistance Received To Date	Insert	New Registration			1/3/2024 12:20 PM
Details	Last Recertification Date	Insert	New Registration			1/3/2024 12:20 PM
Details	Grant Number	Insert	New Registration			1/3/2024 12:20 PM
Details	340B ID	Insert	New Registration			1/3/2024 12:20 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/3/2024 12:20 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/3/2024 12:20 PM
Details	Medicare Provider Number	Insert	New Registration		510007	1/3/2024 12:20 PM
Details	Entity Name	Insert	New Registration		ST. MARYS MEDICAL CENTER INC.	1/3/2024 12:20 PM
Details	NOFO Number	Insert	New Registration			1/3/2024 12:20 PM
Details	Program Code	Insert	New Registration		DSH	1/3/2024 12:20 PM
Details	Entity Subname	Insert	New Registration		HIMG	1/3/2024 12:20 PM
Dates	Participating Approval Date	Insert	New Registration			1/3/2024 12:20 PM
Details	State	Insert	New Registration		Pending	1/3/2024 12:20 PM
Dates	Registration Date	Insert	New Registration		1/3/2024 12:20:56 PM	1/3/2024 12:20 PM
Dates	Signed By Date	Insert	New Registration			1/3/2024 12:20 PM
Dates	Start Date	Insert	New Registration			1/3/2024 12:20 PM
Terminations	Termination Comments	Insert	New Registration			1/3/2024 12:20 PM
Terminations	Termination Date	Insert	New Registration			1/3/2024 12:20 PM
Terminations	Termination Effective Date	Insert	New Registration			1/3/2024 12:20 PM
Terminations	Termination Reason	Insert	New Registration			1/3/2024 12:20 PM