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PHILLIPS PHARMACY INC.
CAH511304-00 Marietta Memorial Hospital of Tyler County, Inc. DBA Sistersville General Hospital
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Covered Entity Details
Entity Name
Marietta Memorial Hospital of Tyler County, Inc. DBA Sistersville General Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511304-00
Entity Address
314 South Wells St
Sistersville, WV 26175
Medicare Provider Number
511304
Participating Start Date
1/1/2012
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
PHILLIPS PHARMACY INC.
Pharmacy Address
DBA PHILLIPS PHARMACY
329 2ND ST
SAINT MARYS, WV 26170
Pharmacy Comments
Contract Details
Approval Date
1/6/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Doug Full, Director of Finance
(740) 374-1698
Contract Pharmacy Representative
Phillips Pharmay
Troy Winland, Owner
(304) 684-3784
Signed By Date
1/6/2022
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