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RITE AID OF WEST VIRGINIA, INC.
CAH511306-00 HOSPITAL DEVELOPMENT CORPORATION DBA ROANE GENERAL HOSPITAL
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Covered Entity Details
Entity Name
HOSPITAL DEVELOPMENT CORPORATION DBA ROANE GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511306-00
Entity Address
200 HOSPITAL DRIVE
SPENCER, WV 25276
Medicare Provider Number
511306
Participating Start Date
7/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
RITE AID OF WEST VIRGINIA, INC.
Pharmacy Address
RITE AID #2694
8699 ELK RIVER ROAD NORTH
CLENDENIN, WV 25045
Pharmacy Comments
Contract Details
Approval Date
7/15/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2018
Ownership change
Contacts
Covered Entity Signing Official
DOUGLAS E. BENTZ, CEO
(304) 927-6200
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
7/15/2014
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