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FRUTH PHARMACY #25
DSH510031 ST FRANCIS HOSPITAL
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Covered Entity Details
Entity Name
ST FRANCIS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510031
Entity Address
333 LAIDLEY STREET
CHARLESTON, WV 25301
Medicare Provider Number
510031
Participating Start Date
4/1/2019
Last Recertification Date
8/29/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
FRUTH PHARMACY #25
Pharmacy Address
FRUTH EXPRESS
701 LEE STREET
CHARLESTON, WV 25301
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Brian Ulery, Chief Operating Officer
(304) 766-3445
Contract Pharmacy Representative
Fruth Pharmacy
Andy Becker, VP Pharmacy
(304) 675-1612 Ext: 10117
Signed By Date
10/15/2019
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