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WAL-MART PHARMACY 10-1499
CH034210 Community Care of West Virginia, Inc.
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Covered Entity Details
Entity Name
Community Care of West Virginia, Inc.
Subdivision Name
Community Care of Rock Cave
Type
HRSA-Funded Health Center
340B ID
CH034210
Entity Address
78 Queens Alley Rd
ROCK CAVE, WV 26234-0217
Grant Number
H80CS00080
Participating Start Date
4/1/2003
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1499
Pharmacy Address
1976 JEFFERSON STREET NORTH
LEWISBURG, WV 24901
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard G Simon, CEO
(304) 924-6262
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/15/2019
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