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CHEAT LAKE PHARMACY
DSH510001 WEST VIRGINIA UNIVERSITY HOSPITALS, INC.
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Covered Entity Details
Entity Name
WEST VIRGINIA UNIVERSITY HOSPITALS, INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510001
Entity Address
1 MEDICAL CENTER DRIVE
MORGANTOWN, WV 26506
Medicare Provider Number
510001
Participating Start Date
7/1/2002
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CHEAT LAKE PHARMACY
Pharmacy Address
509 ASHEBROOKE SQUARE
MORGANTOWN, WV 26508
Pharmacy Comments
Contract Details
Approval Date
10/31/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2017
Agreement registered in error
Contacts
Covered Entity Signing Official
MELISSA MCCOY, VICE PRESIDENT OF FINANCE & CFO
(304) 598-4554
Contract Pharmacy Representative
HRSA
J. Morris, xbvx
(231) 569-8541
Signed By Date
10/1/2016
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