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VIRGINIA CVS PHARMACY, L.L.C.
CAH491307-00 PAGE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PAGE MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH491307-00
Entity Address
200 MEMORIAL DRIVE
LURAY, VA 22835
Medicare Provider Number
491307
Participating Start Date
9/22/2010
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 07593
1404 WEST 211 BYPASS
LURAY, VA 22835
Pharmacy Comments
Contract Details
Approval Date
1/9/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Travis N. Clark, President
(540) 843-4540
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
1/9/2014
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