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WEST VIRGINIA CVS PHARMACY, L.L.C.
CH03099A Monroe County Health Center
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Covered Entity Details
Entity Name
Monroe County Health Center
Subdivision Name
PETERSTOWN CLINIC
Type
HRSA-Funded Health Center
340B ID
CH03099A
Entity Address
2869 Seneca Trail South
PETERSTOWN, WV 24963-0580
Grant Number
H80CS00384
Participating Start Date
4/1/2004
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WEST VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06314
1298 STAFFORD DRIVE
PRINCETON, WV 24740
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
Jim Nelson, CEO
(304) 772-3064 Ext: 129
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/1/2020
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