Covered Entity Details

CAH511312-00 PRESTON MEMORIAL HOSPITAL (Active) - information as of 6/16/2025 5:05:26 AM

Main Details

Name

PRESTON MEMORIAL HOSPITAL

Subdivision Name

Type

Critical Access Hospital

Rural

340B ID

CAH511312-00

Medicare Provider Number

511312

Additional Details

Current Program Status

Active

Registration Date

8/5/2010

Participating Start Date

8/9/2010

Participating Approval Date

8/5/2010

Last Recertification Date

8/29/2024

Contacts

Authorizing Official

Preston Memorial Hospital
KEVIN GESSLER, Vice President Financial Services
(304) 329-1400 Ext: 1120

Primary Contact

Mon Health Preston Memorial Hospital
Jennifer Cunningham, Director of Pharmacy
(304) 329-1400 Ext: 3600

Addresses

Street Address

150 MEMORIAL DRIVE
KINGWOOD, WV 26537-1495

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	BELLDINA'S HEALTH MART	PHARMACY, LLC	107 S. MAIN STREET	MASONTOWN	WV	26542-0112	10/20/2011	08/25/2011	11/01/2018	11/28/2018
Contract Detail	BELLDINA'S HEALTH MART	PHARMACY, LLC	107 S. MAIN STREET	MASONTOWN	WV	26542-0112	07/02/2021	10/01/2021	02/15/2025	03/17/2025
Contract Detail	BRUCETON PHARMACY	198 MORGANTOWN ST, SUITE1		BRUCETON MILLS	WV	26525	04/06/2016	07/01/2016	11/07/2018	11/28/2018
Contract Detail	CENTERWELL PHARMACY, INC.	10737 MARKS WAY		MIRAMAR	FL	33025	04/14/2021	07/01/2021	01/31/2025	03/17/2025
Contract Detail	CENTERWELL PHARMACY, INC.	9843 WINDISCH RD		WEST CHESTER	OH	45069	04/14/2021	07/01/2021	01/31/2025	03/17/2025
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/14/2020	01/01/2021		01/01/2021
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/14/2020	01/01/2021		01/01/2021
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/12/2018	07/01/2018		07/01/2018
Contract Detail	GIANT EAGLE PHARMACY #0058	208 GIANT STREET		MORGANTOWN	WV	26501	07/05/2019	10/01/2019	05/01/2020	06/16/2020
Contract Detail	GIANT EAGLE PHARMACY #0059	130 GREEN BAG ROAD		MORGANTOWN	WV	26501	07/05/2019	10/01/2019	05/01/2020	06/16/2020
Contract Detail	GIANT EAGLE PHARMACY #0221	20160 CENTER RIDGE ROAD, SUITE 201		ROCKY RIVER	OH	44116	07/05/2019	10/01/2019	05/01/2020	06/16/2020
Contract Detail	GIANT EAGLE PHARMACY #8991	2500 LOVI RD		FREEDOM	PA	15042	07/05/2019	10/01/2019	05/01/2020	06/16/2020
Contract Detail	GREGG'S PHARMACY WV, INC.	101 GREGG MEMORIAL DR		TERRA ALTA	WV	26764-1071	01/15/2019	04/01/2019	09/06/2022	12/27/2022
Contract Detail	GREGGS PHARMACY INC	20 N 3RD ST		OAKLAND	MD	21550-1322	04/04/2019	07/01/2019	09/06/2022	12/27/2022
Contract Detail	HIGHLAND PHARMACY AND WELLNESS	198 MORGANTOWN ST STE 1		BRUCETON MILLS	WV	26525-5003	01/08/2021	04/01/2021	09/06/2022	12/27/2022
Contract Detail	KINGWOOD PHARMACY LLC	220 W MAIN ST		KINGWOOD	WV	26537-1419	04/14/2020	07/01/2020		07/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04102	220 NORTH 3RD ST.	OAKLAND	MD	21550	01/15/2020	04/01/2020		04/01/2020
Contract Detail	PRESTON FAMILY PHARMACY	17548 VETERANS MEMORIAL HWY		KINGWOOD	WV	26537-9797	10/07/2015	01/01/2016	11/01/2018	11/28/2018
Contract Detail	PRESTON FAMILY PHARMACY	17548 VETERANS MEMORIAL HWY		KINGWOOD	WV	26537-9797	01/08/2021	04/01/2021		04/01/2021
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	04/12/2018	07/01/2018	10/01/2022	10/13/2023
Contract Detail	RITE AID OF WEST VIRGINIA, INC.	RITE AID #2605	415 EAST MAIN STREET	KINGWOOD	WV	26537	04/03/2014	07/01/2014	02/09/2018	04/12/2018
Contract Detail	VALLEY PHARMACY	VALLEY PHARMACY BUILDING	13150 VETERANS MEMORIAL HWY PO BOX 205	REEDSVILLE	WV	26547	10/20/2011	09/23/2011		03/28/2013
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/25/2017	04/01/2017		01/25/2017
Contract Detail	WAL-MART PHARMACY 10-2083	75 RETAIL CIRCLE		MORGANTOWN	WV	26508	01/05/2016	04/01/2016	01/25/2017	04/24/2017
Contract Detail	WAL-MART PHARMACY 10-2833	1 WAL-MART LANE		GRAFTON	WV	26354	10/07/2015	01/01/2016	05/01/2020	06/16/2020
Contract Detail	WAL-MART PHARMACY 10-2894	13164 GARRETT HIGHWAY		OAKLAND	MD	21550	01/05/2016	04/01/2016	01/25/2017	04/24/2017
Contract Detail	WAL-MART PHARMACY 10-4372	100 WAL-MART DRIVE		KINGWOOD	WV	26537	11/15/2012	11/15/2012		03/28/2013
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/25/2017	04/01/2017		01/25/2017
Contract Detail	WALGREEN CO.	WALGREENS #19666	415 E MAIN ST.	KINGWOOD	WV	26537-1701	04/12/2018	04/17/2018		04/17/2018
Contract Detail	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	10/13/2023	01/01/2024		01/01/2024
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/12/2018	07/01/2018	11/05/2021	07/12/2024
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/12/2018	07/01/2018		07/01/2018
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/12/2018	07/01/2018		07/01/2018
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/12/2018	07/01/2018		07/01/2018
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/14/2023	07/01/2023		07/01/2023
Contract Detail	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03475	300 FAIRMONT AVENUE	FAIRMONT	WV	26554	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06280	1601 EARL L CORE RD.	MORGANTOWN	WV	26505	10/14/2020	01/01/2021		01/01/2021

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH511312-01	Child	CAH	PRESTON MEMORIAL HOSPITAL	PRESTON MEMORIAL FAMILY CARE- FELLO	2287 S. MOUNTAINEER HWY	THORNTON	WV	Terminated
CAH511312-02	Child	CAH	PRESTON MEMORIAL HOSPITAL	PRESTON MEMORIAL FAMILY CARE --KING	150 Memorial Drive	KINGWOOD	WV	Active
CAH511312-03	Child	CAH	PRESTON MEMORIAL HOSPITAL	PRESTON MEMORIAL HOSPITAL URGENT CA	12302 Veterans Memorial Highway	REEDSVILLE	WV	Active
CAH511312-04	Child	CAH	PRESTON MEMORIAL HOSPITAL	PRESTON MEM HOSP PRIMARY CARE- KING - Primary Care	428 Morgantown Street	KINGWOOD	WV	Active
CAH511312-05	Child	CAH	PRESTON MEMORIAL HOSPITAL	PRESTON MEMORIAL PRIMARY CARE-MILES - Primary Care	110 N PRICE ST	KINGWOOD	WV	Active
CAH511312-06	Child	CAH	PRESTON MEMORIAL HOSPITAL	Mon Health Preston Recovery Care Program - Mon Health Preston Recovery Care Program	428 Morgantown Street	Kingwood	WV	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/29/2023 12:32:36 PM	8/29/2024 1:38:07 PM	8/29/2024 1:38 PM
Details	Last Recertification Date	Update	Recertification	9/8/2022 10:48:03 AM	8/29/2023 12:32:36 PM	8/29/2023 12:32 PM
Contacts	Primary Contact	Update	Recertification	WALKER, SHARI Managing Accountant Preston Memorial Hospital 3043291400-1610	Cunningham, Jennifer Director of Pharmacy Mon Health Preston Memorial Hospital 3043291400-3600	9/8/2022 10:48 AM
Details	Last Recertification Date	Update	Recertification	9/1/2021 8:06:32 AM	9/8/2022 10:48:03 AM	9/8/2022 10:48 AM
Contacts	Authorizing Official	Update	Profile Change Request	GESSLER., KEVIN CHIEF FINANCIAL OFFICER Preston Memorial Hospital 3043291400-1120	GESSLER, KEVIN Vice President Financial Services Preston Memorial Hospital 3043291400-1120	1/18/2022 2:05 PM
Contacts	Primary Contact	Update	Profile Change Request	WALKER, SHARI CONTROLLER Preston Memorial Hospital 3043291400-1610	WALKER, SHARI Managing Accountant Preston Memorial Hospital 3043291400-1610	1/12/2022 11:50 AM
Details	Last Recertification Date	Update	Recertification	9/1/2020 2:11:51 PM	9/1/2021 8:06:32 AM	9/1/2021 8:06 AM
Details	Last Recertification Date	Update	Recertification	8/29/2019 2:26:23 PM	9/1/2020 2:11:51 PM	9/1/2020 2:11 PM
Details	Last Recertification Date	Update	Recertification	8/20/2018 2:24:27 PM	8/29/2019 2:26:23 PM	8/29/2019 2:26 PM
Details	Last Recertification Date	Update	Recertification	11/29/2017 12:30:12 PM	8/20/2018 2:24:27 PM	8/20/2018 2:24 PM
Details	Last Recertification Date	Update	Recertification	8/24/2016 12:00:00 AM	11/29/2017 12:30:12 PM	11/29/2017 12:30 PM
Contacts	Primary Contact	Update	Recertification	WALKER, SHARI CONTROLLER 3043291400-1610	WALKER, SHARI CONTROLLER Preston Memorial Hospital 3043291400-1610	11/28/2017 8:14 AM
Contacts	Authorizing Official	Update		GESSLER., KEVIN CHIEF FINANCIAL OFFICER 3043291400-1120	GESSLER., KEVIN CHIEF FINANCIAL OFFICER Preston Memorial Hospital 3043291400-1120	11/16/2017 4:36 PM
Contacts	Authorizing Official	Insert			GESSLER., KEVIN CHIEF FINANCIAL OFFICER 3043291400-1120	4/24/2017 3:55 PM
Addresses	Main Address	Insert			150 MEMORIAL DRIVE KINGWOOD, WV 26537-1495	8/24/2016 12:01 PM
Contacts	Primary Contact	Insert			WALKER, SHARI CONTROLLER 3043291400-1610	8/24/2016 12:01 PM
Details	Last Recertification Date	Update		8/19/2015 12:00:00 AM	8/24/2016 12:00:00 AM	8/24/2016 12:01 PM
Details	Last Recertification Date	Update		8/6/2014 12:00:00 AM	8/19/2015 12:00:00 AM	8/19/2015 4:02 PM
Details	Last Recertification Date	Update		8/19/2013 8:45:33 AM	8/6/2014 12:00:00 AM	8/6/2014 4:37 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/19/2013 8:45:33 AM	8/19/2013 8:45 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	6/1/2012 10:23 AM
Details	Last Recertification Date	Insert				8/9/2010 2:06 PM
Details	Grant Number	Insert				8/9/2010 2:06 PM
Details	340B ID	Insert			CAH511312-00	8/9/2010 2:06 PM
Details	Is Authorizing Official EHB Data	Insert				8/9/2010 2:06 PM
Dates	Last Date That 340B Drugs Purchased	Insert				8/9/2010 2:06 PM
Details	Medicare Provider Number	Insert			511312	8/9/2010 2:06 PM
Details	Entity Name	Insert			PRESTON MEMORIAL HOSPITAL	8/9/2010 2:06 PM
Details	Program Code	Insert			CAH	8/9/2010 2:06 PM
Details	Entity Subname	Insert				8/9/2010 2:06 PM
Dates	Participating Approval Date	Insert			8/5/2010 12:00:00 AM	8/9/2010 2:06 PM
Details	State	Insert			Active	8/9/2010 2:06 PM
Dates	Registration Date	Insert			8/5/2010 12:00:00 AM	8/9/2010 2:06 PM
Dates	Signed By Date	Insert			8/2/2010 12:00:00 AM	8/9/2010 2:06 PM
Dates	Start Date	Insert			8/9/2010 12:00:00 AM	8/9/2010 2:06 PM
Terminations	Termination Comments	Insert				8/9/2010 2:06 PM
Terminations	Termination Date	Insert				8/9/2010 2:06 PM
Terminations	Termination Effective Date	Insert				8/9/2010 2:06 PM
Terminations	Termination Reason	Insert				8/9/2010 2:06 PM