Contract Pharmacy Details

WEST VIRGINIA CVS PHARMACY, L.L.C.
CAH511316-00 GRANT MEMORIAL HOSPITAL, INC.

Covered Entity Details

Entity Name

GRANT MEMORIAL HOSPITAL, INC.

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH511316-00

Entity Address

117 HOSPITAL DRIVE
PETERSBURG, WV 26847

Medicare Provider Number

511316

Participating Start Date

8/12/2010

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

WEST VIRGINIA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04166
743 N MAIN ST
MOOREFIELD, WV 26836

Pharmacy Comments

Contract Details

Approval Date

4/4/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/1/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

JOE BARNES, CHIEF FINANCIAL OFFICER
(304) 257-1026 Ext: 5802

Contract Pharmacy Representative

CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298

Signed By Date

4/4/2014

340B Drug Pricing Program Database