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PHARMACY CORP OF AMERICA DBA MAST LONG T
CAH491305-00 SHENANDOAH MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
SHENANDOAH MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH491305-00
Entity Address
759 SOUTH MAIN STREET
WOODSTOCK, VA 22664
Medicare Provider Number
491305
Participating Start Date
9/27/2010
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
PHARMACY CORP OF AMERICA DBA MAST LONG T
Pharmacy Address
1910 ROSS MILL RD.
HENDERSON, NC 27537
Pharmacy Comments
Contract Details
Approval Date
7/14/2022
Contract Begin Date
7/14/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Peter F. Gallagher, CFO
(540) 536-8031
Contract Pharmacy Representative
Pharmacy Corp of America
Michael Moyano, Senior VP
(502) 494-8836
Signed By Date
7/14/2022
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