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MORGANTOWN DRUG COMPANY, LLC.
CH03421AE Community Care of West Virginia, Inc.
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Covered Entity Details
Entity Name
Community Care of West Virginia, Inc.
Subdivision Name
Pocahontas County High School Wellness Center
Type
HRSA-Funded Health Center
340B ID
CH03421AE
Entity Address
271 Warrior Way
Dunmore, WV 24934-9048
Grant Number
H80CS00080
Participating Start Date
10/1/2014
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
MORGANTOWN DRUG COMPANY, LLC.
Pharmacy Address
DBA GREENBANK PHARMACY
P.O BOX 115, 4498 POTOMAC HIGHLANDS TRA
GREEN BANK, WV 24944
Pharmacy Comments
Contract Details
Approval Date
7/21/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/29/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RICHARD G. SIMON, CEO
(304) 924-6262
Contract Pharmacy Representative
BatJac of South Carolina
TIM ROBBINS, PRESIDENT
(304) 364-5193
Signed By Date
7/21/2014
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