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WEST VIRGINIA CVS PHARMACY, L.L.C.
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
WEST VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY #6311
11078 MIDLAND TRL
GAULEY BRIDGE, WV 25085
Pharmacy Comments
Contract Details
Approval Date
4/4/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/3/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Sherri Murray, CFO
(304) 442-1246
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
4/4/2014
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