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WEST VIRGINIA CVS PHARMACY, L.L.C.
DSH510008 City Hospital, Inc. DBA Berkeley Medical Center
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Covered Entity Details
Entity Name
City Hospital, Inc. DBA Berkeley Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510008
Entity Address
2500 HOSPITAL DRIVE
MARTINSBURG, WV 25401
Medicare Provider Number
510008
Participating Start Date
10/1/2007
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WEST VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 17565
436 RETAIL COMMONS PKWY
MARTINSBURG, WV 25403
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Grover Glendon Kerns, VP of Finance
(304) 260-1443
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2024
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