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VILLAGE LONG TERM PHARMACY LLC
CHC08238-21 CHANGE INC
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Covered Entity Details
Entity Name
CHANGE INC
Subdivision Name
FMC - SBHC Indian Creek High School
Type
HRSA-Funded Health Center
340B ID
CHC08238-21
Entity Address
200 Park Dr
Wintersville, OH 43953-3944
Grant Number
H80CS08238
Participating Start Date
7/1/2024
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
VILLAGE LONG TERM PHARMACY LLC
Pharmacy Address
VILLAGE LONG TERM CARE PHARMACY
204 THREE SPRINGS DR
SUITE B
WEIRTON, WV 26062
Pharmacy Comments
Contract Details
Approval Date
4/11/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lisa Mowry, CEO
(304) 797-7733 Ext: 1311
Contract Pharmacy Representative
Village Pharmacy
Patsy Longhi, Owner
(304) 723-2528
Signed By Date
4/11/2025
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