Contract Pharmacy Details

CVS CAREMARK
CAH511315-00 POTOMAC VALLEY HOSPITAL

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

CVS CAREMARK

Pharmacy Address

DBA CVS/CAREMARK OR CF# 11506
1 GREAT VALLEY BOULEVARD
WILKES BARRE, PA 18706

Pharmacy Comments

Contract Details

Approval Date

1/3/2025

Contract Begin Date

4/1/2025

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

1/3/2025

340B Drug Pricing Program Database