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VAN PROFESSIONAL PHARMACY
FQHCLA128 HYGEIA FACILITIES FOUNDATION, INC.
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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
VAN PROFESSIONAL PHARMACY
Pharmacy Address
19024 POND FORK ROAD
P.O. BOX 450
VAN, WV 25206
Pharmacy Comments
Contract Details
Approval Date
10/9/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/19/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Margaret L. Martin, Executive Director
(304) 854-1323
Contract Pharmacy Representative
Van Pharmacy, Inc.
Robin Moore, Pharmacy Manager
(304) 245-8255
Signed By Date
10/9/2015
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