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WEST VIRGINIA CVS PHARMACY, L.L.C.
CAH511308-00 BRAXTON COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BRAXTON COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511308-00
Entity Address
100 HOYLMAN DRIVE
GASSAWAY, WV 26624-9320
Medicare Provider Number
511308
Participating Start Date
9/21/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WEST VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06307
2907 STATE STREET
GASSAWAY, WV 26624
Pharmacy Comments
Contract Details
Approval Date
1/14/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BEN VINCENT, CEO
(304) 364-1127
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/14/2014
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