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CARL WALKER'S DRUG STORE
CAH511308-00 BRAXTON COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BRAXTON COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511308-00
Entity Address
100 HOYLMAN DRIVE
GASSAWAY, WV 26624-9320
Medicare Provider Number
511308
Participating Start Date
9/21/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CARL WALKER'S DRUG STORE
Pharmacy Address
620 ELK ST
GASSAWAY, WV 26624
Pharmacy Comments
Contract Details
Approval Date
7/10/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Timothy Lewis, COO
(304) 872-2891
Contract Pharmacy Representative
BatJac of South Carolina
TIM ROBBINS, PRESIDENT
(304) 364-5193
Signed By Date
7/10/2024
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