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WEST VIRGINIA CVS PHARMACY, L.L.C.
RRC510039-00 Ohio Valley Medical Center, Incorporated
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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
WEST VIRGINIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06278
842 NATIONAL RD.
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
4/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Lisa M. Simon, Senior Vice President & CFO
(304) 234-8407
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
1/9/2014
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