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WAL-MART PHARMACY 10-2894
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 10-2894
Pharmacy Address
13164 GARRETT HIGHWAY
OAKLAND, MD 21550
Pharmacy Comments
Contract Details
Approval Date
1/5/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/25/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
KEVIN GESSLER, Vice President Financial Services
(304) 329-1400 Ext: 1120
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
1/5/2016
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