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TRI-COUNTY PHARMACY
CH03421AY COMMUNITY CARE OF WEST VIRGINIA, INC.
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Covered Entity Details
Entity Name
COMMUNITY CARE OF WEST VIRGINIA, INC.
Subdivision Name
Johnson Elementary School Wellness Center
Type
HRSA-Funded Health Center
340B ID
CH03421AY
Entity Address
531 JOHNSON AVE
BRIDGEPORT, WV 26330-1311
Grant Number
H80CS00080
Participating Start Date
4/1/2016
Last Recertification Date
2/14/2019
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
TRI-COUNTY PHARMACY
Pharmacy Address
COMMNITY CARE OF WEST VIRGINIA
123 QUEENS ALLEY RD
PO BOX 217
ROCK CAVE, WV 26234
Pharmacy Comments
Contract Details
Approval Date
2/12/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
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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