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WATERFRONT FAMILY PHARMACY
DSH510001 WEST VIRGINIA UNIVERSITY HOSPITALS, INC.
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Covered Entity Details
Entity Name
WEST VIRGINIA UNIVERSITY HOSPITALS, INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510001
Entity Address
1 MEDICAL CENTER DRIVE
MORGANTOWN, WV 26506
Medicare Provider Number
510001
Participating Start Date
7/1/2002
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WATERFRONT FAMILY PHARMACY
Pharmacy Address
215 DON KNOTTS BLVD STE 120
MORGANTOWN, WV 26501-6734
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Melissa D McCoy, Chief Financial Officer
(304) 598-4554
Contract Pharmacy Representative
Waterfront Family Pharmacy, LLC
Karl Sommer, Co-Owner
(304) 685-4311
Signed By Date
10/15/2020
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