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WEST VIRGINIA CVS PHARMACY, L.L.C.
STD41179 Fresh Start Health PSC
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Covered Entity Details
Entity Name
Fresh Start Health PSC
Subdivision Name
Vanceburg Site
Type
Sexually Transmitted Diseases
340B ID
STD41179
Entity Address
207 Plummers Lane
Vanceburg, KY 41179
Grant Number
6NH25PS005135-01-01
Participating Start Date
1/1/2024
Last Recertification Date
5/8/2024
Pharmacy Details
Pharmacy Name
WEST VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04419
505 TWENTIETH STREET
HUNTINGTON, WV 25703
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jerrel Boyer, Medical Director
(606) 923-1124 Ext: 6062258298
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2025
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