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FRUTH PHARMACY OF HURRICANE
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
FRUTH PHARMACY OF HURRICANE
Pharmacy Address
FRUTH PHARMACY #10
3109 TEAYS VALLEY RD
HURRICANE, WV 25526
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Angela Swearingen, VP Finance/CFO
(304) 526-1224
Contract Pharmacy Representative
Fruth Pharmacy
Andy Becker, VP Pharmacy
(304) 675-1612 Ext: 10117
Signed By Date
7/15/2019
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