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ECKERD CORPORATION
SCH490098-00 COMMUNITY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
COMMUNITY MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH490098-00
Entity Address
1755 N MECKLENBURG AVENUE
SOUTH HILL, VA 23970
Medicare Provider Number
490098
Participating Start Date
4/1/2025
Last Recertification Date
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
ECKERD CORPORATION
Pharmacy Address
RITE AID #11305
115 BRUNSWICK SQUARE COURT
LAWRENCEVILLE, VA 23868
Pharmacy Comments
Contract Details
Approval Date
6/28/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/22/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kenneth W. Libby Jr., VP Finance
(434) 774-2530
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
6/28/2013
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