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MARTIN'S PHARMACY #6107
SCH490005-00 WINCHESTER MEDICAL CENTER
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Covered Entity Details
Entity Name
WINCHESTER MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH490005-00
Entity Address
1840 AMHERST STREET
WINCHESTER, VA 22601
Medicare Provider Number
490005
Participating Start Date
1/22/2021
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
MARTIN'S PHARMACY #6107
Pharmacy Address
901 FOXCROFT AVENUE
MARTINSBURG, WV 25401
Pharmacy Comments
Contract Details
Approval Date
1/16/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/14/2024
OPA Terminated due to audit finding
Contacts
Covered Entity Signing Official
Peter F. Gallagher, CFO
(540) 536-8031
Contract Pharmacy Representative
The Giant Company
Nick Koch, Regional Pharmacy Manager
(484) 655-0805
Signed By Date
1/16/2023
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