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WALGREEN CO.
CH030820 MONONGAHELA VALLEY ASN HLTH CTRS
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Covered Entity Details
Entity Name
MONONGAHELA VALLEY ASN HLTH CTRS
Subdivision Name
MVA Health Center - Fairmont
Type
HRSA-Funded Health Center
340B ID
CH030820
Entity Address
1322 LOCUST AVENUE
FAIRMONT, WV 26554
Grant Number
H80CS00383
Participating Start Date
10/1/1995
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #19094
208 S PIKE ST.
SHINNSTON, WV 26431-1122
Pharmacy Comments
Contract Details
Approval Date
2/27/2018
Contract Begin Date
2/27/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
NANCY L. VANDERGRIFT, CEO
(304) 367-8740
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
2/27/2018
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