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NICHOLAS PHARMACY, INC
CAH511301-00 WEBSTER MEMORIAL HOSPITAL, INC.
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Covered Entity Details
Entity Name
WEBSTER MEMORIAL HOSPITAL, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511301-00
Entity Address
125 Diana Drive
WEBSTER SPRINGS, WV 26288
Medicare Provider Number
511301
Participating Start Date
4/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
NICHOLAS PHARMACY, INC
Pharmacy Address
421 MAIN STREET
SUMMERSVILLE, WV 26651
Pharmacy Comments
Contract Details
Approval Date
7/8/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/15/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
DEBORAH BRAGG, INTERIM CFO
(304) 847-5682 Ext: 5700
Contract Pharmacy Representative
Jerry H. Leonard, Director of Pharmacy
(304) 345-4836 Ext: 220
Signed By Date
7/8/2014
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