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WV UNIVERSITY HOSPITALS INC
CAH511321-00 ST. JOSEPHS HOSPITAL
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Covered Entity Details
Entity Name
ST. JOSEPHS HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511321-00
Entity Address
1 AMALIA DRIVE
BUCKHANNON, WV 26201
Medicare Provider Number
511321
Participating Start Date
10/1/2015
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WV UNIVERSITY HOSPITALS INC
Pharmacy Address
DBA MEDICAL CENTER PHARMACY
1 MEDICAL CENTER DR
MORGANTOWN, WV 26506-1200
Pharmacy Comments
Contract Details
Approval Date
10/12/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/15/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Russell J. Plywaczynski, Director of Finance
(304) 460-7955
Contract Pharmacy Representative
WVU Medicine
David Flynn, Director of Outpatient Pharmacy
(304) 598-6915
Signed By Date
10/12/2017
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