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WEST VIRGINIA CVS PHARMACY, L.L.C.
DSH510029 Thomas Memorial Hospital
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Covered Entity Details
Entity Name
Thomas Memorial Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510029
Entity Address
4605 MacCorkle Avenue, SW
South Charleston, WV 25309
Medicare Provider Number
510029
Participating Start Date
7/1/2014
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WEST VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06312
2811 ROBERT C. BYRD DR.
BECKLEY, WV 25801
Pharmacy Comments
Contract Details
Approval Date
1/9/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/19/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian L Ulery, Chief Operating Officer (COO)
(304) 766-3445
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/9/2020
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