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BATJAC OF SOUTH CAROLINA
CH03421L Community Care of West Virginia, Inc.
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Covered Entity Details
Entity Name
Community Care of West Virginia, Inc.
Subdivision Name
Community Dental Care of Green Bank
Type
HRSA-Funded Health Center
340B ID
CH03421L
Entity Address
6404 Potomac Highlands Trail
Green Bank, WV 24944
Grant Number
H80CS00080
Participating Start Date
7/1/2014
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
BATJAC OF SOUTH CAROLINA
Pharmacy Address
DBA POCAHONTAS PHARMACY
P.O. BOX 148
105 DUNCAN RD
MARLINTON, WV 24954
Pharmacy Comments
Contract Details
Approval Date
7/11/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/16/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RICHARD G. SIMON, CEO
(304) 924-6262
Contract Pharmacy Representative
Signed By Date
7/11/2014
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