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ARACOMA DRUG CO OF CHAPMANVIL
CAH511313-00 BOONE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BOONE MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511313-00
Entity Address
701 Madison Avenue
MADISON, WV 25130
Medicare Provider Number
511313
Participating Start Date
1/1/2011
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
ARACOMA DRUG CO OF CHAPMANVIL
Pharmacy Address
772 MAIN STREET
BOX 1570
CHAPMANVILLE, WV 25508-1570
Pharmacy Comments
Contract Details
Approval Date
7/7/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/12/2021
Ownership change
Contacts
Covered Entity Signing Official
RANDELL Davis FOXX, CFO
(304) 369-1230 Ext: 5508
Contract Pharmacy Representative
ARACOMA DRUG CO OF CHAPMANVILLE
Michael Baker, Pharmacists
(304) 855-4541
Signed By Date
7/7/2015
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