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SOUTH FORK PHARMACY
CH033130 E.A. HAWSE HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
E.A. HAWSE HEALTH CENTER, INC.
Subdivision Name
Central Office
Type
HRSA-Funded Health Center
340B ID
CH033130
Entity Address
17978 STATE ROUTE 55
BAKER, WV 26801-0097
Grant Number
H80CS00563
Participating Start Date
10/1/2004
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
SOUTH FORK PHARMACY
Pharmacy Address
WILLIAMS PHARMACY HOLDINGS #1, LLC
732 N MAIN ST
MOOREFIELD, WV 26836
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/24/2024
Ownership change
Contacts
Covered Entity Signing Official
GARY T. JOHNSON, CEO
(304) 897-5915 Ext: 230
Contract Pharmacy Representative
South Fork Pharmacy
Bradley Williams, Owner
(304) 530-1044
Signed By Date
4/15/2014
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