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CH03421Q Community Care of West Virginia, Inc. (Terminated)
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Main Details
Name
Community Care of West Virginia, Inc.
Subdivision Name
Lumberport Middle School Wellness Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-012890
340B ID
CH03421Q
Grant Number
H80CS00080
Additional Details
Current Program Status
Terminated
Registration Date
7/12/2014
Participating Start Date
10/1/2014
Participating Approval Date
7/21/2014
Last Recertification Date
2/16/2016
Termination Date
Termination Reason
1/1/2017
Site closure
Contacts
Authorizing Official
Community Care of West Virginia
Richard G. Simon, CEO
(304) 924-6262
Primary Contact
TERRY L. CRAIG, DIRECTOR OF PHARMACY SERVICES
(304) 471-2250
Addresses
Street Address
Rt 1 Box 2
Lumberport, WV 26386
Billing Address
TRI-COUNTY HEALTH CLINIC
78 QUEENS ALLEY RD
PO BOX 217
ROCK CAVE, WV 26234
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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