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WHITE HALL PHARMACY, LLC.
DSH510006 UNITED HOSPITAL CENTER
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Covered Entity Details
Entity Name
UNITED HOSPITAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510006
Entity Address
327 MEDICAL PARK DRIVE
BRIDGEPORT, WV 26330
Medicare Provider Number
510006
Participating Start Date
10/1/2016
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WHITE HALL PHARMACY, LLC.
Pharmacy Address
177 MIDDLETOWN RD STE 2
FAIRMONT, WV 26554-8254
Pharmacy Comments
Contract Details
Approval Date
4/13/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Rutkowski, VP Finance/CFO
(681) 342-1605
Contract Pharmacy Representative
White Hall Pharmacy
Gene C. Wright, owner
(304) 368-9355
Signed By Date
4/13/2022
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