Contract Pharmacy Details

FRUTH
DSH510055 Cabell Huntington Hospital, Inc.

Covered Entity Details

Entity Name

Cabell Huntington Hospital, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH510055

Entity Address

1340 Hal Greer Blvd.
Huntington, WV 25701-0195

Medicare Provider Number

510055

Participating Start Date

4/1/2005

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

FRUTH

Pharmacy Address

FRUTH PHARMACY #20
501 ROOSEVELT BLVD
ELEANOR, WV 25070

Pharmacy Comments

Contract Details

Approval Date

10/5/2013

Contract Begin Date

1/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/15/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

David M. Ward, SENIOR VP AND CfO
(304) 526-2274

Contract Pharmacy Representative

Timothy Weber, Pharmacy Director
(304) 201-1630

Signed By Date

10/5/2013