Contract Pharmacy Details

STANLEY PHARMACY
CAH491307-00 PAGE MEMORIAL HOSPITAL

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

STANLEY PHARMACY

Pharmacy Address

308 EAST MAIN STREET
PO BOX 160
STANLEY, VA 22851

Pharmacy Comments

Contract Details

Approval Date

1/12/2015

Contract Begin Date

4/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2017
Pharmacy closed

Contacts

Covered Entity Signing Official

Travis N. Clark, President
(540) 843-4540

Contract Pharmacy Representative

Shentel
Vance Bryant, Owner
(540) 778-2219

Signed By Date

1/12/2015