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WEST VIRGINIA CVS PHARMACY, L.L.C.
DSH510055 Cabell Huntington Hospital, Inc.
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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
WEST VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
CVS/PHARMACY #10566
278 E MAIN STREET
MILTON, WV 25541
Pharmacy Comments
Contract Details
Approval Date
10/10/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David M. Ward, SENIOR VP AND CfO
(304) 526-2274
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
10/10/2016
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