Contract Pharmacy Details

CAMC PHARMACY #3
HV25304 CAMC HEALTH EDUCATION & RESEARCH INSTITUTE

Covered Entity Details

Entity Name

CAMC HEALTH EDUCATION & RESEARCH INSTITUTE

Subdivision Name

Type

Ryan White Part C

340B ID

HV25304

Entity Address

3211 MACCORKLE AVENUE, SE
CHARLESTON, WV 25304

Grant Number

H76HA00762

Participating Start Date

7/1/2002

Last Recertification Date

2/24/2021

Entity Termination Date

1/1/2022

Pharmacy Details

Pharmacy Name

CAMC PHARMACY #3

Pharmacy Address

3415 MacCorkle Ave SE
Charleston, WV 25304

Pharmacy Comments

Contract Details

Approval Date

7/27/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Christine A. Teague, Director
(304) 388-8106

Contract Pharmacy Representative

Vandalia Health
Brian Sayre, VP of Pharmacy Services
(304) 388-8917

Signed By Date

7/27/2017

340B Drug Pricing Program Database