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MARYLAND CVS PHARMACY, L.L.C.
CH030890 PRESTON TAYLOR COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
PRESTON TAYLOR COMMUNITY HEALTH CENTER
Subdivision Name
Preston-Taylor Community Health
Type
HRSA-Funded Health Center
340B ID
CH030890
Entity Address
725 N Pike St
Grafton, WV 26354-1270
Grant Number
H80CS00617
Participating Start Date
7/1/2004
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
MARYLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04102
220 NORTH 3RD ST.
OAKLAND, MD 21550
Pharmacy Comments
Contract Details
Approval Date
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
June Griffith, COO
(304) 265-0312
Contract Pharmacy Representative
PTCHC
Charles Michael Dickey, Pharmacist
(304) 265-7400
Signed By Date
4/11/2023
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