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CH03421AY COMMUNITY CARE OF WEST VIRGINIA, INC. (Terminated)
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Main Details
Name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Subdivision Name
Johnson Elementary School Wellness Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-014811
340B ID
CH03421AY
Grant Number
H80CS00080
Additional Details
Current Program Status
Terminated
Registration Date
1/5/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/12/2016
Last Recertification Date
2/14/2019
Termination Date
Termination Reason
4/1/2020
Site closure
Contacts
Authorizing Official
Community Care of West Virginia
Richard G Simon, CEO
(304) 924-6262
Primary Contact
Community Care of West Virginia
Joshua Dunn, Pharmacist
(304) 473-2291
Addresses
Street Address
531 JOHNSON AVE
BRIDGEPORT, WV 26330-1311
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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June 2025
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