340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
MOUNTAIN LAKE PHARMACY
CH033100 CAMDEN-ON-GAULEY MEDICAL CENTER, INC.
Print
Covered Entity Details
Entity Name
CAMDEN-ON-GAULEY MEDICAL CENTER, INC.
Subdivision Name
CAMDEN-ON-GAULEY MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH033100
Entity Address
10003 Webster Rd
Camden On Gauley, WV 26208
Grant Number
H80CS00078
Participating Start Date
12/1/1992
Last Recertification Date
2/23/2025
Pharmacy Details
Pharmacy Name
MOUNTAIN LAKE PHARMACY
Pharmacy Address
1129 BROAD ST
STE 100
SUMMERSVILLE, WV 26651
Pharmacy Comments
Contract Details
Approval Date
1/10/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Margaret Hickey, CEO
(304) 226-5725
Contract Pharmacy Representative
Mountain Lake Pharmacy
Howard Stephen Boone, President
(304) 872-9000
Signed By Date
1/10/2019
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