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DANVILLE PHARMACY
CAH511313-00 BOONE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BOONE MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511313-00
Entity Address
701 Madison Avenue
MADISON, WV 25130
Medicare Provider Number
511313
Participating Start Date
1/1/2011
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
DANVILLE PHARMACY
Pharmacy Address
2008 SMOOT AVENUE
DANVILLE, WV 25053
Pharmacy Comments
Contract Details
Approval Date
6/26/2019
Contract Begin Date
6/26/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Virgil Lee Underwood, CEO
(304) 369-1230 Ext: 5507
Contract Pharmacy Representative
Danville Pharmacy
Chad Moles, Owner
(304) 369-3981
Signed By Date
6/26/2019
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