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BELLDINA'S HEALTH MART
CAH511312-00 PRESTON MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PRESTON MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511312-00
Entity Address
150 MEMORIAL DRIVE
KINGWOOD, WV 26537-1495
Medicare Provider Number
511312
Participating Start Date
8/9/2010
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
BELLDINA'S HEALTH MART
Pharmacy Address
PHARMACY, LLC
107 S. MAIN STREET
MASONTOWN, WV 26542-0112
Pharmacy Comments
Contract Details
Approval Date
10/20/2011
Contract Begin Date
8/25/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ROBERT W. MILVET Jr., CHIEF FINANCIAL OFFICER
(304) 329-4700
Contract Pharmacy Representative
Preston Family Pharmacy
Eric Belldina, Owner
(304) 864-4000
Signed By Date
9/1/2011
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