340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
CYSTIC FIBROSIS SERVICES, LLC
CAH511316-00 GRANT MEMORIAL HOSPITAL, INC.
Print
Covered Entity Details
Entity Name
GRANT MEMORIAL HOSPITAL, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511316-00
Entity Address
117 HOSPITAL DRIVE
PETERSBURG, WV 26847
Medicare Provider Number
511316
Participating Start Date
8/12/2010
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
CYSTIC FIBROSIS SERVICES, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16280
10530 JOHN W ELLIOTT DR STE 200
FRISCO, TX 75033
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mary Beth Barr, Chief Executive Officer
(304) 257-1026 Ext: 5800
Contract Pharmacy Representative
Grant Memorial Hospital
Brent R Harman, Director of Pharmacy
(304) 257-1026 Ext: 2440
Signed By Date
1/15/2018
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session