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VAN PROFESSIONAL PHARMACY
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
VAN PROFESSIONAL PHARMACY
Pharmacy Address
19024 POND FORK ROAD
P.O. BOX 450
VAN, WV 25206
Pharmacy Comments
Contract Details
Approval Date
7/4/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/24/2021
Ownership change
Contacts
Covered Entity Signing Official
Martha Carter, CEO
(304) 760-6316
Contract Pharmacy Representative
Van Pharmacy, Inc.
Robin Moore, Pharmacy Manager
(304) 245-8255
Signed By Date
7/4/2016
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