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OHIO CVS STORES, L.L.C.
DSH510058 CAMDEN-CLARK MEMORIAL HOSP
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Covered Entity Details
Entity Name
CAMDEN-CLARK MEMORIAL HOSP
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510058
Entity Address
800 GARFIELD AVENUE
PARKERSBURG, WV 26101
Medicare Provider Number
510058
Participating Start Date
10/1/2015
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
OHIO CVS STORES, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03422
131 3RD ST.
MARIETTA, OH 45750
Pharmacy Comments
Contract Details
Approval Date
1/18/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kyle Anthony Pierson, CFO
(304) 424-2202
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/18/2022
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