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WEST VIRGINIA CVS PHARMACY, L.L.C.
DSH510030 DAVIS MEDICAL CENTER
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Covered Entity Details
Entity Name
DAVIS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510030
Entity Address
812 Gorman Avenue
ELKINS, WV 26241
Medicare Provider Number
510030
Participating Start Date
1/1/2005
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WEST VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03439
505 RANDOLPH AVE
ELKINS, WV 26241
Pharmacy Comments
Contract Details
Approval Date
1/3/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/9/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
REBECCA J. HAMMER, VICE PRESIDENT FOR FINANCE
(304) 637-3156
Contract Pharmacy Representative
John R. Zevzavadjian, Vice President, Managed Care
(401) 770-5503
Signed By Date
1/3/2014
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