Covered Entity Details

CAH371323-03 WEATHERFORD HOSPITAL AUTHORITY (Approved) - information as of 6/16/2025 11:23:32 PM

Main Details

Name

WEATHERFORD HOSPITAL AUTHORITY

Subdivision Name

WRH OBGYN CLINIC - OBGYN CLINIC

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH371323-03

Medicare Provider Number

371323

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/15/2025

Participating Start Date

7/1/2025

Participating Approval Date

5/2/2025

Last Recertification Date

Contacts

Authorizing Official

Weatherford Regional Hospital
Darin Farrell, President
(580) 774-4750

Primary Contact

Weatherford Regional Hospital
Jeremy Garrett, Director of Pharmacy
(580) 772-5551 Ext: 747

Addresses

Street Address

3739 LEGACY STREET
WEATHERFORD, OK 73096

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	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH371323-01	Child	CAH	WEATHERFORD HOSPITAL AUTHORITY	WHR CONVENIENT CARE CLINIC	215 N KANSAS ST	WEATHERFORD	OK	Terminated
CAH371323-02	Child	CAH	WEATHERFORD HOSPITAL AUTHORITY	WEATHERFORD HOSPITAL AUTHORITY - WRH FAMILY PRACTICE	3743 LEGACY DRIVE	WEATHERFORD	OK	Approved
CAH371323-03	Child	CAH	WEATHERFORD HOSPITAL AUTHORITY	WRH OBGYN CLINIC - OBGYN CLINIC	3739 LEGACY STREET	WEATHERFORD	OK	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Farrell, Darin President Weatherford Regional Hospital 5807744750	5/2/2025 1:16 PM
Details	340B ID	Update	New Registration		CAH371323-03	5/2/2025 1:16 PM
Details	Entity Name	Update	New Registration	WEATHERFORD REGIONAL HOSPITAL	WEATHERFORD HOSPITAL AUTHORITY	5/2/2025 1:16 PM
Details	Entity Subname	Update	New Registration	WRH OBGYN CLINIC	WRH OBGYN CLINIC - OBGYN CLINIC	5/2/2025 1:16 PM
Dates	Participating Approval Date	Update	New Registration		5/2/2025 1:16:34 PM	5/2/2025 1:16 PM
Details	State	Update	New Registration	Pending	Approved	5/2/2025 1:16 PM
Dates	Signed By Date	Update	New Registration		4/28/2025 11:00:19 AM	5/2/2025 1:16 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	5/2/2025 1:16 PM
Addresses	Main Address	Insert	New Registration		3739 LEGACY STREET WEATHERFORD, OK 73096	4/15/2025 4:56 PM
Contacts	Primary Contact	Insert	New Registration		Garrett, Jeremy Director of Pharmacy Weatherford Regional Hospital 5807725551-747	4/15/2025 4:56 PM
Contacts	Authorizing Official	Insert	New Registration		Farrell, Darin President Weatherford Regional Hospital 5807744750	4/15/2025 4:56 PM
Details	Assistance Received From Date	Insert	New Registration			4/15/2025 4:56 PM
Details	Assistance Received To Date	Insert	New Registration			4/15/2025 4:56 PM
Details	Last Recertification Date	Insert	New Registration			4/15/2025 4:56 PM
Details	Grant Number	Insert	New Registration			4/15/2025 4:56 PM
Details	340B ID	Insert	New Registration			4/15/2025 4:56 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/15/2025 4:56 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/15/2025 4:56 PM
Details	Medicare Provider Number	Insert	New Registration		371323	4/15/2025 4:56 PM
Details	Entity Name	Insert	New Registration		WEATHERFORD REGIONAL HOSPITAL	4/15/2025 4:56 PM
Details	NOFO Number	Insert	New Registration			4/15/2025 4:56 PM
Details	Program Code	Insert	New Registration		CAH	4/15/2025 4:56 PM
Details	Entity Subname	Insert	New Registration		WRH OBGYN CLINIC	4/15/2025 4:56 PM
Dates	Participating Approval Date	Insert	New Registration			4/15/2025 4:56 PM
Details	State	Insert	New Registration		Pending	4/15/2025 4:56 PM
Dates	Registration Date	Insert	New Registration		4/15/2025 4:56:12 PM	4/15/2025 4:56 PM
Dates	Signed By Date	Insert	New Registration			4/15/2025 4:56 PM
Dates	Start Date	Insert	New Registration			4/15/2025 4:56 PM
Terminations	Termination Comments	Insert	New Registration			4/15/2025 4:56 PM
Terminations	Termination Date	Insert	New Registration			4/15/2025 4:56 PM
Terminations	Termination Effective Date	Insert	New Registration			4/15/2025 4:56 PM
Terminations	Termination Reason	Insert	New Registration			4/15/2025 4:56 PM