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WEST VIRGINIA CVS PHARMACY, L.L.C.
CAH491307-00 PAGE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PAGE MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH491307-00
Entity Address
200 MEMORIAL DRIVE
LURAY, VA 22835
Medicare Provider Number
491307
Participating Start Date
9/22/2010
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WEST VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04166
743 N MAIN ST
MOOREFIELD, WV 26836
Pharmacy Comments
Contract Details
Approval Date
10/7/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/7/2020
Agreement registered in error
Contacts
Covered Entity Signing Official
Peter F. Gallagher, CFO
(540) 536-8031
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/7/2020
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