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TRI-COUNTY PHARMACY
CH03409A Community Care of West Virginia, Inc.
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Covered Entity Details
Entity Name
Community Care of West Virginia, Inc.
Subdivision Name
Community Care of Big Otter
Type
HRSA-Funded Health Center
340B ID
CH03409A
Entity Address
797 Clinic Dr
Ivydale, WV 25113-8263
Grant Number
H80CS00080
Participating Start Date
9/9/2005
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
TRI-COUNTY PHARMACY
Pharmacy Address
COMMNITY CARE OF WEST VIRGINIA
123 QUEENS ALLEY RD
PO BOX 217
ROCK CAVE, WV 26234
Pharmacy Comments
Contract Details
Approval Date
7/18/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2020
Agreement registered in error
Contacts
Covered Entity Signing Official
RICHARD G. SIMON, CEO
(304) 924-6262
Contract Pharmacy Representative
TERRY L. CRAIG, DIRECTOR OF PHARMACY SERVICES
(304) 471-2250
Signed By Date
7/18/2014
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