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WEST VIRGINIA CVS PHARMACY, L.L.C.
CH031600 TRI-STATE COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
TRI-STATE COMMUNITY HEALTH CENTER
Subdivision Name
TRI-STATE COMMUNITY HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH031600
Entity Address
130 W High St
Hancock, MD 21750-1143
Grant Number
H80CS00069
Participating Start Date
12/1/1992
Last Recertification Date
3/10/2025
Pharmacy Details
Pharmacy Name
WEST VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01427
45 S. MINERAL ST.
KEYSER, WV 26726
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
SHEILA DESHONG, COO
(301) 678-5187 Ext: 226
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2019
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