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HIGHLANDER PHARMACY
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
HIGHLANDER PHARMACY
Pharmacy Address
HIGHLANDER PHARMACY
117 BACK FORK ST
WEBSTER SPRINGS, WV 26288-1032
Pharmacy Comments
Contract Details
Approval Date
1/18/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Deborah Bragg, CFO
(304) 847-5682 Ext: 5700
Contract Pharmacy Representative
Highlander Pharmacy
Jeff Kesecker, POC
(304) 847-5151
Signed By Date
1/18/2016
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