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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
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
PRIME THERAPEUTICS SPECIALTY PHARMACY LL
Pharmacy Address
ALLIANCERX WALGREENS PRIME #16568
2354 COMMERCE PARK DRIVE
SUITE 100
ORLANDO, FL 32819-9992
Pharmacy Comments
Contract Details
Approval Date
4/12/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
KEVIN GESSLER, Vice President Financial Services
(304) 329-1400 Ext: 1120
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2018
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