Contract Pharmacy Details

RITE AID OF WEST VIRGINIA, INC.
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

RITE AID OF WEST VIRGINIA, INC.

Pharmacy Address

RITE AID #968
6401 US ROUTE 60 EAST
BARBOURSVILLE, WV 25504

Pharmacy Comments

Contract Details

Approval Date

7/15/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/16/2018
Ownership change

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

7/15/2016

340B Drug Pricing Program Database