340B Drug Pricing Program Database
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PHILLIPS PHARMACY INC.
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
PHILLIPS PHARMACY INC.
Pharmacy Address
DBA PHILLIPS PHARMACY
329 2ND ST
SAINT MARYS, WV 26170
Pharmacy Comments
Contract Details
Approval Date
4/14/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kyle Anthony Pierson, CFO
(304) 424-2202
Contract Pharmacy Representative
Phillips Pharmacy
Tammy Smith, Owner
(304) 684-3784
Signed By Date
4/14/2022
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