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WEST END PHARMACY
CAH491303-00 DICKENSON COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
DICKENSON COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH491303-00
Entity Address
312 HOSPITAL DRIVE
CLINTWOOD, VA 24228-0000
Medicare Provider Number
491303
Participating Start Date
10/1/2017
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WEST END PHARMACY
Pharmacy Address
340 COLLEY SHOPPING CTR
CLINTWOOD, VA 24228
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shane Hilton, VP/CFO - Market Operations
(423) 302-3467
Contract Pharmacy Representative
WEST END PHARMACY
John Sutherland, Owner
(276) 926-6890
Signed By Date
4/16/2018
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