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WV UNIVERSITY HOSPITALS INC.
CAH511319-00 JEFFERSON MEDICAL CENTER
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Covered Entity Details
Entity Name
JEFFERSON MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511319-00
Entity Address
300 S. PRESTON STREET
RANSON, WV 25438-1631
Medicare Provider Number
511319
Participating Start Date
9/29/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WV UNIVERSITY HOSPITALS INC.
Pharmacy Address
MOUNTAINEER PHARMACY
390 BIRCH ST
MORGANTOWN, WV 26505-6894
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kathleen R. Quinones, VP FINANCE
(304) 260-1443
Contract Pharmacy Representative
WVU Medicine
Louis Sokos, Director of Pharmacy
(304) 598-4578
Signed By Date
10/16/2017
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