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GAULEY RIVER PHARMACY
CH033100 CAMDEN-ON-GAULEY MEDICAL CENTER, INC.
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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
GAULEY RIVER PHARMACY
Pharmacy Address
GAULEY RIVER PHARMACY, INC.
433 CRAIGSVILLE RD.
SUITE 2
CRAIGSVILLE, WV 26205
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
Gauley River Pharmacy
Kris Moose, Owner
(304) 742-5001
Signed By Date
1/10/2019
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