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TRI-COUNTY HEALTH CLINIC INC DBA PRIMARY
CH03409C Community Care of West Virginia, Inc.
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Covered Entity Details
Entity Name
Community Care of West Virginia, Inc.
Subdivision Name
Clay Elementary School Wellness Center
Type
HRSA-Funded Health Center
340B ID
CH03409C
Entity Address
168 Church St
Clay, WV 25043-9420
Grant Number
H80CS00080
Participating Start Date
9/9/2005
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
TRI-COUNTY HEALTH CLINIC INC DBA PRIMARY
Pharmacy Address
122 CENTER STREET
PO BOX 939
CLAY, WV 25043
Pharmacy Comments
3/26/10 UPDATED ADD (WAS 125 CENTER STREET, PO BOX 147)
Contract Details
Approval Date
8/1/2009
Contract Begin Date
8/1/2009
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/10/2016
Agreement registered in error
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
TERRY L. CRAIG, PHARMACY DIRECTOR
(304) 924-6784
Signed By Date
6/22/2009
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