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WEST VIRGINIA CVS PHARMACY, L.L.C.
CAH511322-00 West Virginia Health Care Cooperative, Inc. DBA Summersville Regional Medical Center
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Covered Entity Details
Entity Name
West Virginia Health Care Cooperative, Inc. DBA Summersville Regional Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511322-00
Entity Address
400 FAIRVIEW HEIGHTS ROAD
SUMMERSVILLE, WV 26651
Medicare Provider Number
511322
Participating Start Date
7/1/2019
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WEST VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05946
72 WHITEWATER AVE.
FAYETTEVILLE, WV 25840
Pharmacy Comments
Contract Details
Approval Date
1/14/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Timothy Lewis, COO
(304) 872-2891
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/14/2025
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