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WEST VIRGINIA CVS PHARMACY, L.L.C.
DSH510006 UNITED HOSPITAL CENTER
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Covered Entity Details
Entity Name
UNITED HOSPITAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510006
Entity Address
327 MEDICAL PARK DRIVE
BRIDGEPORT, WV 26330
Medicare Provider Number
510006
Participating Start Date
10/1/2016
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WEST VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03186
701 E. MAIN STREET
CLARKSBURG, WV 26301
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Rutkowski, VP Finance/CFO
(681) 342-1605
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/15/2020
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