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CENTRA CANCER CENTER PHARMACY
SCH490021-00 CENTRA HEALTH
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Covered Entity Details
Entity Name
CENTRA HEALTH
Subdivision Name
Lynchburg General Hospital
Type
Sole Community Hospital
340B ID
SCH490021-00
Entity Address
1920 ATHERHOLT ROAD
LYNCHBURG, VA 24501
Medicare Provider Number
490021
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
CENTRA CANCER CENTER PHARMACY
Pharmacy Address
1701 THOMSON DR
LYNCHBURG, VA 24501-1118
Pharmacy Comments
Contract Details
Approval Date
7/12/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
DAVID G. GOUGH, CFO
(434) 200-4712
Contract Pharmacy Representative
Centra Health
Randall Puckett, Managing Director of Pharmacy
(434) 200-3179
Signed By Date
7/12/2018
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