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WEST VIRGINIA CVS PHARMACY, L.L.C.
CH033080 RAINELLE MEDICAL CENTER
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Covered Entity Details
Entity Name
RAINELLE MEDICAL CENTER
Subdivision Name
RAINELLE MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH033080
Entity Address
176 Medical Center Drive
Rainelle, WV 25962-1013
Grant Number
H80CS18278
Participating Start Date
4/1/1996
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WEST VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04432
300 FOURTH AVE
MONTGOMERY, WV 25136
Pharmacy Comments
Contract Details
Approval Date
4/4/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KRISTI ATHA-RADER, CEO
(304) 438-6188 Ext: 1006
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/4/2024
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