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MACE'S PHARMACY, INC.
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
MACE'S PHARMACY, INC.
Pharmacy Address
204 S CRIM AVE
BELINGTON, WV 26250
Pharmacy Comments
Contract Details
Approval Date
7/18/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
REBECCA J. HAMMER, VICE PRESIDENT FOR FINANCE
(304) 637-3156
Contract Pharmacy Representative
Rich Mace, Onwer
(304) 823-1001
Signed By Date
7/18/2014
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