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WAL-MART PHARMACY 10-2576
CH031820 CABIN CREEK HEALTH SYSTEMS, INC.
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Covered Entity Details
Entity Name
CABIN CREEK HEALTH SYSTEMS, INC.
Subdivision Name
Cabin Creek Health Center
Type
HRSA-Funded Health Center
340B ID
CH031820
Entity Address
5722 Cabin Creek Road
DAWES, WV 25054-0070
Grant Number
H80CS00294
Participating Start Date
4/1/2001
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2576
Pharmacy Address
100 NITRO MARKETPLACE
CROSS LANES, WV 25313
Pharmacy Comments
Contract Details
Approval Date
10/10/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
CRAIG ROBINSON, CEO
(304) 734-2040 Ext: 102
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/10/2019
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