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PENNSYLVANIA CVS PHARMACY, L.L.C.
CHC24159-00 River Valley Health
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Covered Entity Details
Entity Name
River Valley Health
Subdivision Name
River Valley Health - Williamsport Medical and Dental
Type
HRSA-Funded Health Center
340B ID
CHC24159-00
Entity Address
471 Hepburn St
Williamsport, PA 17701-6122
Grant Number
H80CS24159
Participating Start Date
4/1/2013
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01608
220 MAIN STREET
WATSONTOWN, PA 17777
Pharmacy Comments
Contract Details
Approval Date
7/8/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/23/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Jim Yoxtheimer, President & CEO
(570) 567-5412
Contract Pharmacy Representative
Wellpartner
Bryn Wolgemuth, Account Manager
(917) 607-0428
Signed By Date
7/8/2022
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