340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
VAN PROFESSIONAL PHARMACY
CAH511313-00 BOONE MEMORIAL HOSPITAL
Print
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
VAN PROFESSIONAL PHARMACY
Pharmacy Address
19024 POND FORK ROAD
P.O. BOX 450
VAN, WV 25206
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
7/1/2018
Ownership change
Contacts
Covered Entity Signing Official
RANDELL Davis FOXX, CFO
(304) 369-1230 Ext: 5508
Contract Pharmacy Representative
Van Pharmacy, Inc.
Robin Moore, Pharmacy Manager
(304) 245-8255
Signed By Date
7/7/2015
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session