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CAH511315-01 POTOMAC VALLEY HOSPITAL (Active)
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Main Details
Name
POTOMAC VALLEY HOSPITAL
Subdivision Name
PVH RHC Riverside
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH511315-01
Medicare Provider Number
511315
Outpatient Facility Provider Number
513414
Additional Details
Current Program Status
Active
Registration Date
10/6/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/17/2016
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
West Virginia University Healthcare
Justin Gibson, VP of Finance-North Region
(304) 598-4256
Primary Contact
WVU Medicine
Jessica Ileen Calderone, Enterprise 340B Program Manager
(304) 598-4000 Ext: 70847
Addresses
Street Address
32 2nd St
Piedmont, WV 26750
Billing Address
PVH RHC Riverside
100 Pin Oak Lane
Keyser, WV 26726
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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