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VIRGINIA CVS PHARMACY, L.L.C.
SCH490021-00 CENTRA HEALTH, INC
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Covered Entity Details
Entity Name
CENTRA HEALTH, INC
Subdivision Name
Lynchburg General Hospital
Type
Sole Community Hospital
340B ID
SCH490021-00
Entity Address
1901 TATE SPRINGS RD
LYNCHBURG, VA 24501
Medicare Provider Number
490021
Participating Start Date
4/1/2011
Last Recertification Date
8/31/2022
Entity Termination Date
10/1/2023
Pharmacy Details
Pharmacy Name
VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 07002
112 S. MAIN ST. / P.O. BOX 1017
AMHERST, VA 24521
Pharmacy Comments
Contract Details
Approval Date
4/13/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/31/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert E. Tonkinson, SR VICE PRESIDENT & CHIEF FINANCIAL OFFICER
(434) 200-4708
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/13/2017
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