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WEST VIRGINIA CVS PHARMACY, L.L.C.
CH030820 MONONGAHELA VALLEY ASN HLTH CTRS
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Covered Entity Details
Entity Name
MONONGAHELA VALLEY ASN HLTH CTRS
Subdivision Name
MVA Health Center - Fairmont
Type
HRSA-Funded Health Center
340B ID
CH030820
Entity Address
1322 LOCUST AVENUE
FAIRMONT, WV 26554
Grant Number
H80CS00383
Participating Start Date
10/1/1995
Last Recertification Date
2/19/2025
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
10/1/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
NANCY L. VANDERGRIFT, CEO
(304) 367-8740
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/1/2020
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