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WAL-MART PHARMACY 10-4372
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
WAL-MART PHARMACY 10-4372
Pharmacy Address
100 WAL-MART DRIVE
KINGWOOD, WV 26537
Pharmacy Comments
Contract Details
Approval Date
11/15/2012
Contract Begin Date
11/15/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ROBERT W. MILVET Jr., CHIEF FINANCIAL OFFICER
(304) 329-4700
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
10/10/2012
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