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COMMUNITY CARE OF WEST VIRGINIA
CH03421AM COMMUNITY CARE OF WEST VIRGINIA, INC.
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Covered Entity Details
Entity Name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Subdivision Name
Bridgeport High School Wellness Center
Type
HRSA-Funded Health Center
340B ID
CH03421AM
Entity Address
515 JOHNSON AVE
BRIDGEPORT, WV 26330-1311
Grant Number
H80CS00080
Participating Start Date
4/1/2016
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
COMMUNITY CARE OF WEST VIRGINIA
Pharmacy Address
DBA COMMUNITY CARE PHARMACY OF WESTON
107 STAUNTON DR
WESTON, WV 26452
Pharmacy Comments
Contract Details
Approval Date
1/7/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2020
Agreement registered in error
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
TERRY L. CRAIG, DIRECTOR OF PHARMACY SERVICES
(304) 471-2250
Signed By Date
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