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CAH511315-14 POTOMAC VALLEY HOSPITAL (Terminated)
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Main Details
Name
POTOMAC VALLEY HOSPITAL
Subdivision Name
Rural Health Clinic II - Ft Ashby - Pediatrics
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH511315-14
Medicare Provider Number
511315
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2022
Participating Start Date
10/1/2022
Participating Approval Date
7/27/2022
Last Recertification Date
8/12/2024
Termination Date
Termination Reason
4/1/2025
Site closure
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
10261 Frankfort Highway
1st Floor
Fort Ashby, WV 26719-4533
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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