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TRI-COUNTY HEALTH CLINIC INC DBA PRIMARY
CH03421E Community Care of West Virginia, Inc.
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Covered Entity Details
Entity Name
Community Care of West Virginia, Inc.
Subdivision Name
Braxton Healthcare Associates
Type
HRSA-Funded Health Center
340B ID
CH03421E
Entity Address
617 River Street
Gassaway, WV 26624-1137
Grant Number
H80CS00080
Participating Start Date
7/1/2009
Last Recertification Date
2/16/2016
Entity Termination Date
1/1/2017
Pharmacy Details
Pharmacy Name
TRI-COUNTY HEALTH CLINIC INC DBA PRIMARY
Pharmacy Address
122 CENTER STREET
PO BOX 939
CLAY, WV 25043
Pharmacy Comments
3/26/10 UPDATED ADD (WAS 125 CENTER STREET, PO BOX 147)
Contract Details
Approval Date
7/18/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2017
Contacts
Covered Entity Signing Official
RICHARD G. SIMON, CEO
(304) 924-6262
Contract Pharmacy Representative
TERRY L. CRAIG, DIRECTOR OF PHARMACY SERVICES
(304) 471-2250
Signed By Date
7/18/2014
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