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FRUTH PHARMACY #25
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
FRUTH PHARMACY #25
Pharmacy Address
FRUTH EXPRESS
701 LEE STREET
CHARLESTON, WV 25301
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
Fruth Pharmacy
Tom Willoughby, Chief Financial Officer
(304) 675-1612 Ext: 163
Signed By Date
10/10/2019
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