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VANDERBILT HEALTH PHARMACY GROUP
DSH510007 ST. MARYS MEDICAL CENTER INC.
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Covered Entity Details
Entity Name
ST. MARYS MEDICAL CENTER INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510007
Entity Address
2900 FIRST AVENUE
HUNTINGTON, WV 25702-1241
Medicare Provider Number
510007
Participating Start Date
7/1/2016
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
VANDERBILT HEALTH PHARMACY GROUP
Pharmacy Address
718 MELROSE AVE
NASHVILLE, TN 37211-3721
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/17/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Angela Swearingen, VP Finance/CFO
(304) 526-1224
Contract Pharmacy Representative
Vanderbilt Health Pharmacy Group
James R Manfred, Executive Director, VHPG
(615) 322-4775
Signed By Date
4/15/2019
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