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RITE AID OF WEST VIRGINIA, INC.
CAH511318-00 Montgomery General Hospital, Inc
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Covered Entity Details
Entity Name
Montgomery General Hospital, Inc
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511318-00
Entity Address
401 Sixth Avenue
Montgomery, WV 25136
Medicare Provider Number
511318
Participating Start Date
7/1/2012
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
RITE AID OF WEST VIRGINIA, INC.
Pharmacy Address
RITE AID #1013
2100 EAST DUPONT AVE
BELLE, WV 25015
Pharmacy Comments
Contract Details
Approval Date
11/28/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/13/2018
Ownership change
Contacts
Covered Entity Signing Official
Vicki Gay, President and CEO
(304) 442-5151
Contract Pharmacy Representative
Rite Aid
Ruth Lightner, Director
(717) 731-6524
Signed By Date
10/11/2012
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