340B Drug Pricing Program Database
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DSH510058P CAMDEN-CLARK MEMORIAL HOSP (Terminated)
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Main Details
Name
CAMDEN-CLARK MEMORIAL HOSP
Subdivision Name
Primary Care - Primary Care PMC III
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH510058P
Medicare Provider Number
510058
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2022
Participating Start Date
10/1/2022
Participating Approval Date
8/10/2022
Last Recertification Date
8/15/2023
Termination Date
Termination Reason
10/1/2024
Site closure
Contacts
Authorizing Official
Camden Clark Medical Center DBA Camden-Clark Memorial Hospital
Kyle Anthony Pierson, CFO
(304) 424-2202
Primary Contact
WVU Medicine
Barbra Sue May, Enterprise Manager, 340B Program
(304) 290-9830
Addresses
Street Address
418 Grand Park Drive
Second Floor
Suite 321
Parkersburg, WV 26105
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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