Contract Pharmacy Details

MOUNTAINEER DRUG INC.
FQHCLA128 HYGEIA FACILITIES FOUNDATION, INC.

Covered Entity Details

Entity Name

HYGEIA FACILITIES FOUNDATION, INC.

Subdivision Name

RALEIGH BOONE MEDICAL CENTER

Type

Health Center Program Look-Alike

340B ID

FQHCLA128

Entity Address

37456 COAL RIVER ROAD
WHITESVILLE, WV 25209

Grant Number

LALCS00039

Participating Start Date

4/1/2004

Last Recertification Date

2/27/2023

Entity Termination Date

7/1/2023

Pharmacy Details

Pharmacy Name

MOUNTAINEER DRUG INC.

Pharmacy Address

76 LEWIS STREET
WHITESVILLE, WV 25209

Pharmacy Comments

Contract Details

Approval Date

7/23/2015

Contract Begin Date

10/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/10/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Margaret L. Martin, Executive Director
(304) 854-1323

Contract Pharmacy Representative

Mountaineer Drug
Aaron Smarr, Owner
(304) 380-8769

Signed By Date

7/23/2015

340B Drug Pricing Program Database