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RITE AID OF WEST VIRGINIA, INC.
DSH510058 CAMDEN-CLARK MEMORIAL HOSP
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Covered Entity Details
Entity Name
CAMDEN-CLARK MEMORIAL HOSP
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510058
Entity Address
800 GARFIELD AVENUE
PARKERSBURG, WV 26101
Medicare Provider Number
510058
Participating Start Date
10/1/2015
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
RITE AID OF WEST VIRGINIA, INC.
Pharmacy Address
RITE AID #1460
1960 EAST 7TH STREET
PARKERSBURG, WV 26101
Pharmacy Comments
Contract Details
Approval Date
8/10/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/9/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David K. McClure, President/CEO
(304) 424-2204
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President, Managed Care
(717) 975-5968
Signed By Date
8/10/2015
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