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WV UNIVERSITY HOSPITALS INC
DSH510006 UNITED HOSPITAL CENTER
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Covered Entity Details
Entity Name
UNITED HOSPITAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510006
Entity Address
327 MEDICAL PARK DRIVE
BRIDGEPORT, WV 26330
Medicare Provider Number
510006
Participating Start Date
10/1/2016
Last Recertification Date
8/15/2024
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
11/21/2017
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
James Rutkowski, VP Finance/CFO
(681) 342-1605
Contract Pharmacy Representative
WVU Medicine
David Flynn, Director of Outpatient Pharmacy
(304) 598-6915
Signed By Date
11/21/2017
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