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CAH511315-02 POTOMAC VALLEY HOSPITAL (Terminated)
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Main Details
Name
POTOMAC VALLEY HOSPITAL
Subdivision Name
PVH RHC Elk Garden
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH511315-02
Medicare Provider Number
511315
Outpatient Facility Provider Number
513981
Additional Details
Current Program Status
Terminated
Registration Date
10/6/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/17/2016
Last Recertification Date
8/28/2018
Termination Date
Termination Reason
10/1/2019
Site closure
Contacts
Authorizing Official
Potomac Valley Hospital
Justin J Gibson, VP of Finance
(304) 598-4256
Primary Contact
Potomac Valley Hospital
Jonathan Troup, Director of Pharmacy
(304) 597-3659
Addresses
Street Address
48 Oak Street
Elk Garden, WV 26717
Billing Address
PVH RHC Elk Garden
100 Pin Oak Lane
Keyser, WV 26726
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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