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GIANT EAGLE PHARMACY #0059
DSH510001J WEST VIRGINIA UNIVERSITY HOSPITALS, INC.
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Covered Entity Details
Entity Name
WEST VIRGINIA UNIVERSITY HOSPITALS, INC.
Subdivision Name
WVUH-Medicine Suite 3 Clinic
Type
Disproportionate Share Hospital
340B ID
DSH510001J
Entity Address
1 Medical Center Drive
Morgantown, WV 26506
Medicare Provider Number
510001
Outpatient Facility Provider Number
Participating Start Date
10/1/2013
Last Recertification Date
9/6/2022
Entity Termination Date
10/1/2023
Pharmacy Details
Pharmacy Name
GIANT EAGLE PHARMACY #0059
Pharmacy Address
130 GREEN BAG ROAD
MORGANTOWN, WV 26501
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/12/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
Melissa D McCoy, Chief Financial Officer
(304) 598-4554
Contract Pharmacy Representative
Giant Eagle, Inc.
Mike Bianco, Senior Pharmacy Manager
(412) 967-3718
Signed By Date
10/15/2020
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