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FRUTH PHARMACY #25
DSH510022 CHARLESTON AREA MEDICAL CENTER (CAMC)
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Covered Entity Details
Entity Name
CHARLESTON AREA MEDICAL CENTER (CAMC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510022
Entity Address
501 MORRIS STREET
CHARLESTON, WV 25301
Medicare Provider Number
510022
Participating Start Date
9/22/2005
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
FRUTH PHARMACY #25
Pharmacy Address
FRUTH EXPRESS
701 LEE STREET
CHARLESTON, WV 25301
Pharmacy Comments
Contract Details
Approval Date
1/3/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/12/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
STEPHEN BELL, VICE PRESIDENT - FINANCE
(304) 388-6251
Contract Pharmacy Representative
Fruth Pharmacy
Tom Willoughby, Chief Financial Officer
(304) 675-1612 Ext: 163
Signed By Date
1/3/2019
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