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WEST VIRGINIA CVS PHARMACY, L.L.C.
CAH491300-03 Bath County Community Hospital, Inc.
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Covered Entity Details
Entity Name
Bath County Community Hospital, Inc.
Subdivision Name
Rural Health Clinic IV - Rural Health Clinic
Type
Critical Access Hospital
340B ID
CAH491300-03
Entity Address
322 W. Riverside Street
Covington, VA 24426
Medicare Provider Number
491300
Outpatient Facility Provider Number
493461
Participating Start Date
1/1/2023
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WEST VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06333
9781 SENECA TRAIL S.
LEWISBURG, WV 24901
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tom Vandenhoven, CFO
(540) 839-7138
Contract Pharmacy Representative
Caremark L.L.C.
Christian reid, 340b Program Director
(401) 770-2118
Signed By Date
10/16/2023
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