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CAH511319-00 JEFFERSON MEDICAL CENTER (Active)
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Main Details
Name
JEFFERSON MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH511319-00
Medicare Provider Number
511319
Additional Details
Current Program Status
Active
Registration Date
8/2/2010
Participating Start Date
9/29/2010
Participating Approval Date
8/3/2010
Last Recertification Date
8/21/2024
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
300 S. PRESTON STREET
RANSON, WV 25438-1631
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/30/12 - Added Medicaid # and NPI #
03/30/2012
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