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DSH510022EQ CHARLESTON AREA MEDICAL CENTER (CAMC) (Active)
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Main Details
Name
CHARLESTON AREA MEDICAL CENTER (CAMC)
Subdivision Name
CAMC PED DEPARTMENTS - Pediatric Rheumatology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH510022EQ
Medicare Provider Number
510022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/6/2022
Participating Start Date
10/1/2022
Participating Approval Date
8/1/2022
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
CAMC Health System
Jeff D Sandene, EVP CFO
(304) 388-7603
Primary Contact
Vandalia Health
Brian Sayre, VP of Pharmacy Services
(304) 388-8917
Addresses
Street Address
830 Pennsylvania Avenue
Suite 103
Charleston, WV 25302
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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