Contract Pharmacy Details

WEST VIRGINIA CVS PHARMACY, L.L.C.
DSH510031 ST FRANCIS HOSPITAL

Covered Entity Details

Entity Name

ST FRANCIS HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH510031

Entity Address

333 LAIDLEY STREET
CHARLESTON, WV 25301

Medicare Provider Number

510031

Participating Start Date

4/1/2019

Last Recertification Date

8/29/2023

Entity Termination Date

7/1/2024

Pharmacy Details

Pharmacy Name

WEST VIRGINIA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04207
4205 MACCORKLE AVE.
CHARLESTON, WV 25304

Pharmacy Comments

Contract Details

Approval Date

2/27/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Brian Ulery, Chief Operating Officer
(304) 766-3445

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/15/2019

340B Drug Pricing Program Database