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DELIVERCARERX PHARMACY LLC
CAH511303-00 Minnie Hamilton Health Care Center, INC
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Covered Entity Details
Entity Name
Minnie Hamilton Health Care Center, INC
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511303-00
Entity Address
186 Hospital Dr
Grantsville, WV 26147-7100
Medicare Provider Number
511303
Participating Start Date
4/1/2014
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
DELIVERCARERX PHARMACY LLC
Pharmacy Address
DELIVERCARERX PHARMACY LLC
1471 E BUSINESS CENTER DR
STE 200
MT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
7/5/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/4/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Stephen Whited, CEO
(304) 354-9244 Ext: 5183
Contract Pharmacy Representative
Agape
Dave Krishna, CEO
(847) 965-1600
Signed By Date
7/5/2017
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