Contract Pharmacy Details

RITE AID OF WEST VIRGINIA, INC.
RRC510039-00 Ohio Valley Medical Center, Incorporated

Covered Entity Details

Entity Name

Ohio Valley Medical Center, Incorporated

Subdivision Name

Type

Rural Referral Center

340B ID

RRC510039-00

Entity Address

2000 Eoff Street
Wheeling, WV 26003

Medicare Provider Number

510039

Participating Start Date

7/1/2013

Last Recertification Date

8/13/2015

Entity Termination Date

4/1/2016

Pharmacy Details

Pharmacy Name

RITE AID OF WEST VIRGINIA, INC.

Pharmacy Address

RITE AID #733
111 KRUGER STREET
WHEELING, WV 26003

Pharmacy Comments

Contract Details

Approval Date

1/9/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/12/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Lisa M. Simon, Senior Vice President & CFO
(304) 234-8407

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

1/9/2014

340B Drug Pricing Program Database