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CUSTOMSCRIPT INFUSION VITAL CARE
CH038440 WOMENCARE, INC.
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Covered Entity Details
Entity Name
WOMENCARE, INC.
Subdivision Name
FamilyCare Health Center - Teays Valley
Type
HRSA-Funded Health Center
340B ID
CH038440
Entity Address
97 Great Teays Blvd STE 6
Scott Depot, WV 25560-9816
Grant Number
H80CS00827
Participating Start Date
7/1/2000
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
CUSTOMSCRIPT INFUSION VITAL CARE
Pharmacy Address
DBA CUSTOMSCRIPT PHARMACY
3738 TEAYS VALLEY RD
SUITE C
HURRICANE, WV 25526
Pharmacy Comments
Contract Details
Approval Date
4/10/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/19/2016
Pharmacy closed
Contacts
Covered Entity Signing Official
Martha Carter, CEO
(304) 760-6316
Contract Pharmacy Representative
Chad Wallace, Owner
(304) 543-3292
Signed By Date
4/10/2015
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