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CAH511319-04 JEFFERSON MEDICAL CENTER (Active)
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Main Details
Name
JEFFERSON MEDICAL CENTER
Subdivision Name
General Surgery Ranson - General Surgery Ranson
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH511319-04
Medicare Provider Number
511319
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/9/2024
Participating Start Date
10/1/2024
Participating Approval Date
7/10/2024
Last Recertification Date
Contacts
Authorizing Official
WVU Medicine East
Grover Glendon Kerns, VP of Finance
(304) 260-1443
Primary Contact
The Charles Town General Hospital dba Jefferson Medical Center
JONATHAN Matthew KLINE, DIRECTOR OF PHARMACY
(304) 728-1768
Addresses
Street Address
203 East 4th Ave
Ranson, WV 25438
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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