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WEST VIRGINIA CVS PHARMACY, L.L.C.
CHC06642-02 Western Maryland Health Care Corporation
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Covered Entity Details
Entity Name
Western Maryland Health Care Corporation
Subdivision Name
Mountain Laurel Medical Center Westernport
Type
HRSA-Funded Health Center
340B ID
CHC06642-02
Entity Address
22221 Westernport Rd SW
Westernport, MD 21562-2206
Grant Number
H80CS06642
Participating Start Date
1/1/2020
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WEST VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01427
45 S. MINERAL ST.
KEYSER, WV 26726
Pharmacy Comments
Contract Details
Approval Date
7/6/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRIAN BAILEY, CEO
(301) 533-3300 Ext: 3056
Contract Pharmacy Representative
CVS
MARK KELLY, Director of Business Development
(619) 402-0671
Signed By Date
7/6/2023
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