Contract Pharmacy Details

CARL WALKER'S DRUG STORE
CH03421Z Community Care of West Virginia, Inc.

Covered Entity Details

Entity Name

Community Care of West Virginia, Inc.

Subdivision Name

Braxton County Middle School Wellness Center

Type

HRSA-Funded Health Center

340B ID

CH03421Z

Entity Address

100 Carter Braxton Dr
Sutton, WV 26601-9773

Grant Number

H80CS00080

Participating Start Date

10/1/2014

Last Recertification Date

2/17/2025

Pharmacy Details

Pharmacy Name

CARL WALKER'S DRUG STORE

Pharmacy Address

620 ELK ST
GASSAWAY, WV 26624

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

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

BatJac of South Carolina
TIM ROBBINS, PRESIDENT
(304) 364-5193

Signed By Date

7/21/2014

340B Drug Pricing Program Database