340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WEST VIRGINIA CVS PHARMACY, L.L.C.
DSH510038 STONEWALL JACKSON MEMORIAL HOSPITAL
Print
Covered Entity Details
Entity Name
STONEWALL JACKSON MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510038
Entity Address
230 Hospital Plaza
WESTON, WV 26452
Medicare Provider Number
510038
Participating Start Date
1/1/2019
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WEST VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05947
250 COURT STREET
WESTON, WV 26452
Pharmacy Comments
Contract Details
Approval Date
10/8/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin Stalnaker, Chief Administrative Officer
(304) 269-8152
Contract Pharmacy Representative
West Virginia CVS Pharmacy, LLC
John R. Zevzavadjian, Vice President, Payer Relations
(401) 770-5503
Signed By Date
10/8/2018
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session