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VAN PHARMACY, INC
CH030850 LINCOLN COUNTY PRIMARY CARE CENTER, INC.
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Covered Entity Details
Entity Name
LINCOLN COUNTY PRIMARY CARE CENTER, INC.
Subdivision Name
LINCOLN COUNTY PRIMARY CARE CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH030850
Entity Address
7400 Lynn Ave
Hamlin, WV 25523-1138
Grant Number
H80CS00254
Participating Start Date
1/1/2004
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
VAN PHARMACY, INC
Pharmacy Address
19024 POND FORK ROAD
PO BOX 450
VAN, WV 25206
Pharmacy Comments
Contract Details
Approval Date
4/10/2023
Contract Begin Date
5/31/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lisa King Leach, CEO
(304) 824-5806 Ext: 1236
Contract Pharmacy Representative
Van Pharmacy, Inc.
Robin Moore, Pharmacy Manager
(304) 245-8255
Signed By Date
4/10/2023
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