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WV UNIVERSITY HOSPITALS INC
DSH510008 City Hospital, Inc. DBA Berkeley Medical Center
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Covered Entity Details
Entity Name
City Hospital, Inc. DBA Berkeley Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510008
Entity Address
2500 HOSPITAL DRIVE
MARTINSBURG, WV 25401
Medicare Provider Number
510008
Participating Start Date
10/1/2007
Last Recertification Date
8/13/2024
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
10/16/2017
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
Kathleen R. Quinones, VP FINANCE
(304) 260-1443
Contract Pharmacy Representative
WVU Medicine
Joedell Gonzaga, Director Ambulatory Pharmacy Services
(304) 598-4000 Ext: 73034
Signed By Date
10/16/2017
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