Contract Pharmacy Details

DRUG EMPORIUM
DSH510022 CHARLESTON AREA MEDICAL CENTER (CAMC)

Covered Entity Details

Entity Name

CHARLESTON AREA MEDICAL CENTER (CAMC)

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH510022

Entity Address

501 MORRIS STREET
CHARLESTON, WV 25301

Medicare Provider Number

510022

Participating Start Date

9/22/2005

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

DRUG EMPORIUM

Pharmacy Address

1603 KANAWHA BLVD WEST
CHARLESTON, WV 25387

Pharmacy Comments

Contract Details

Approval Date

10/16/2022

Contract Begin Date

1/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/12/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

Jeff D Sandene, EVP CFO
(304) 388-7603

Contract Pharmacy Representative

Drug Emporium WV
Sherry Witters, Director of Pharmacy Operations
(304) 345-4836

Signed By Date

10/16/2022

340B Drug Pricing Program Database