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WEST VIRGINIA CVS PHARMACY, L.L.C.
CAH511315-00 POTOMAC VALLEY HOSPITAL
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Covered Entity Details
Entity Name
POTOMAC VALLEY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511315-00
Entity Address
100 PIN OAK LANE
KEYSER, WV 26726
Medicare Provider Number
511315
Participating Start Date
4/1/2016
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WEST VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05961
30 HERITAGE CIRCLE
ROMNEY, WV 26757
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
Justin Gibson, VP of Finance-North Region
(304) 598-4256
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2024
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