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CMC PHARMACY, LLC
DSH510022 CHARLESTON AREA MEDICAL CENTER (CAMC)
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Covered Entity Details
Entity Name
CHARLESTON AREA MEDICAL CENTER (CAMC)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510022
Entity Address
501 MORRIS STREET
CHARLESTON, WV 25301
Medicare Provider Number
510022
Participating Start Date
9/22/2005
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
CMC PHARMACY, LLC
Pharmacy Address
BIOMATRIX SPECIALTY PHARMACY WV
3100 MACCORKLE AVE SE STE 100
CHARLESTON, WV 25304-1215
Pharmacy Comments
Contract Details
Approval Date
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/17/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
LARRY HUDSON, EXECUTIVE VICE PRESIDENT AND CFO
(304) 388-7603
Contract Pharmacy Representative
Nicholas Karalis, President
(304) 344-8021
Signed By Date
10/17/2016
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