340B Drug Pricing Program Database


DSH370178 ADAIR COUNTY HEALTH CENTER (Active) - information as of 6/21/2025 12:09:50 AM

Main Details
ADAIR COUNTY HEALTH CENTER
Disproportionate Share Hospital
No
DSH370178
370178


Additional Details
Active
1/15/2015
4/1/2015
2/10/2015
8/22/2024

Contacts

ADAIR COUNTY HEALTH CENTER INC.
JAMES W CAUSON, PRES & CEO
(918) 696-3101 Ext: 210

Hospital
Tammy R Paden, Administrative Assistant
(918) 696-3101 Ext: 238

Addresses

1401 W. Locust Street
STILWELL, OK 74960

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

No
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract Detail870 SOUTHERN DRUG CORPD/B/A AVITA PHARMACY 1064 924 MYRTLE AVE
BROOKLYNNY1120610/15/202101/01/2022 04/25/202404/25/2024
Contract DetailAVITA PHARMACY 1026PHARMBLUE ARIZONA LLC 1260 S CAMPBELL AVE STE 1152
GREEN VALLEYAZ85614-050410/14/201901/01/2020 04/25/202404/25/2024
Contract DetailAVITA PHARMACY 1031PHARMBLUE HOLDINGS LLC D/B/A AVITA PHARM 1495 N 7TH ST STE B
BEAUMONTTX77702-134510/15/202101/01/2022 04/25/202404/25/2024
Contract DetailAVITA PHARMACY 1040AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10 6100 CORPORATE BLVD STE 250
BATON ROUGELA7080810/15/202101/01/2022 04/01/202404/25/2024
Contract DetailAVITA PHARMACY 1060RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH 40 PENNWOOD PL STE 200
WARRENDALEPA15086-662510/14/201901/01/2020 04/25/202404/25/2024
Contract DetailAVITA PHARMACY 1061PHARMBLUE MASSACHUSETTS LLC DBA AVITA PH 163 PLEASANT ST
ATTLEBOROMA02703-245710/15/202101/01/2022 04/25/202404/25/2024
Contract DetailLONGS DRUGS OF LEXINGTOND/B/A AVITA PHARMACY 1051 1216 W MAIN ST
STE D 		LEXINGTONSC29072-245310/15/202101/01/2022 04/25/202404/25/2024
Contract DetailPHARMBLUE LLC DBA AVITA PHARMACY 10591226 CHESTNUT ST
PHILADELPHIAPA1910710/14/201901/01/2020 04/25/202404/25/2024
Contract DetailSTILWELL PHARMACYSTILWELL DRUG COMPANY LLC 202 S 2ND ST
STILWELLOK7496006/09/202506/09/2025  06/09/2025
Contract DetailSTILWELL PHARMACY INC202 S 2ND ST
STILWELLOK7496004/08/201507/01/2015 06/09/202506/09/2025
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/08/201507/01/2015 04/01/202404/25/2024
Contract DetailWAL-MART PHARMACY 10-008184127 HIGHWAY 59
STILWELLOK7496004/08/201507/01/2015 04/01/202404/25/2024
Contract DetailWAL-MART PHARMACY 10-53152354 COMMERCE PARK DR.
ORLANDOFL3281910/14/201901/01/2020 04/01/202404/25/2024
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/08/201507/01/2015 04/01/202404/25/2024
Contract DetailWALGREEN CO.DBA: WALGREENS #10785 1905 S. MUSKOGEE AVE.
TAHLEQUAHOK74464-543610/15/202101/01/2022 04/25/202404/25/2024
Contract DetailWALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275607/19/202310/01/2023 04/01/202404/25/2024
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification8/18/2023 8:30:34 AM8/22/2024 8:45:25 AM8/22/2024 8:45 AM
DetailsLast Recertification DateUpdateRecertification8/31/2022 6:49:02 AM8/18/2023 8:30:34 AM8/18/2023 8:30 AM
ContactsAuthorizing OfficialUpdateChange RequestBradley, Daniel Chief Executive Officer Adair County Health Center 9186963101CAUSON, JAMES W PRES & CEO ADAIR COUNTY HEALTH CENTER INC. 9186963101-2107/19/2023 9:06 AM
DetailsLast Recertification DateUpdateRecertification9/15/2021 6:34:20 AM8/31/2022 6:49:02 AM8/31/2022 6:49 AM
DetailsLast Recertification DateUpdateRecertification9/3/2020 2:43:34 PM9/15/2021 6:34:20 AM9/15/2021 6:34 AM
DetailsLast Recertification DateUpdateRecertification9/15/2019 1:42:11 PM9/3/2020 2:43:34 PM9/3/2020 2:43 PM
ContactsAuthorizing OfficialUpdateChange RequestAdams, Alan Chief Executive Officer Adair County Health Center dba/ Memorial Hospital 9186963101Bradley, Daniel Chief Executive Officer Adair County Health Center 91869631018/14/2020 11:19 AM
DetailsLast Recertification DateUpdateRecertification8/23/2018 1:41:15 PM9/15/2019 1:42:11 PM9/15/2019 1:42 PM
DetailsLast Recertification DateUpdateRecertification11/8/2017 1:53:02 PM8/23/2018 1:41:15 PM8/23/2018 1:41 PM
Medicaid BillingMedicaid: NumberDeleteRecertification1790753358 (OK) 11/8/2017 1:53 PM
Medicaid BillingNPI: NumberDeleteRecertification1790753358 ( ) 11/8/2017 1:53 PM
Medicaid BillingNPI: NumberDeleteRecertification1235286311 ( ) 11/8/2017 1:53 PM
Medicaid BillingNPI: NumberDeleteRecertification1568789790 ( ) 11/8/2017 1:53 PM
ContactsPrimary ContactUpdateRecertificationAdams, Alan Chief Executive Officer Adair County Health Center dba/ Memorial Hospital 9186963101Paden, Tammy R Administrative Assistant Hospital 9186963101-23811/8/2017 1:53 PM
DetailsLast Recertification DateUpdateRecertification8/16/2016 12:00:00 AM11/8/2017 1:53:02 PM11/8/2017 1:53 PM
AddressesMain AddressInsert   1401 W. Locust Street STILWELL, OK 749608/16/2016 4:48 PM
ContactsAuthorizing OfficialInsert  Adams, Alan Chief Executive Officer Adair County Health Center dba/ Memorial Hospital 91869631018/16/2016 4:48 PM
ContactsPrimary ContactInsert  Adams, Alan Chief Executive Officer Adair County Health Center dba/ Memorial Hospital 91869631018/16/2016 4:48 PM
ContactsSigned ByInsert  Adams, Alan Chief Executive Officer Adair County Health Center dba/ Memorial Hospital 91869631018/16/2016 4:48 PM
DetailsLast Recertification DateUpdate 9/4/2015 12:00:00 AM8/16/2016 12:00:00 AM8/16/2016 4:48 PM
DetailsLast Recertification DateUpdate  9/4/2015 12:00:00 AM9/4/2015 7:30 AM
DatesParticipating Approval DateUpdate  2/10/2015 12:00:00 AM2/10/2015 10:41 AM
DetailsStateUpdate PendingActive2/10/2015 10:41 AM
DatesStart DateUpdate  4/1/2015 12:00:00 AM2/10/2015 10:41 AM
Details340B IDUpdate ONLINE_REG_49909DSH3701781/27/2015 11:44 AM
Details340B IDUpdate  ONLINE_REG_499091/15/2015 4:21 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False1/15/2015 4:21 PM
Medicaid BillingMedicaid: NumberInsert  17907533581/15/2015 4:21 PM
Medicaid BillingMedicaid: StateInsert  OK1/15/2015 4:21 PM
Medicaid BillingNPI: NumberInsert  17907533581/15/2015 4:21 PM
Medicaid BillingNPI: NumberInsert  12352863111/15/2015 4:21 PM
Medicaid BillingNPI: NumberInsert  15687897901/15/2015 4:21 PM
DetailsLast Recertification DateInsert   1/15/2015 4:21 PM
DetailsGrant NumberInsert   1/15/2015 4:21 PM
Details340B IDInsert   1/15/2015 4:21 PM
DetailsIs Authorizing Official EHB DataInsert   1/15/2015 4:21 PM
DatesLast Date That 340B Drugs PurchasedInsert   1/15/2015 4:21 PM
DetailsMedicare Provider NumberInsert  3701781/15/2015 4:21 PM
DetailsEntity NameInsert  ADAIR COUNTY HEALTH CENTER1/15/2015 4:21 PM
DetailsProgram CodeInsert  DSH1/15/2015 4:21 PM
DetailsEntity SubnameInsert   1/15/2015 4:21 PM
DatesParticipating Approval DateInsert   1/15/2015 4:21 PM
DetailsStateInsert  Pending1/15/2015 4:21 PM
DatesRegistration DateInsert  1/15/2015 12:00:00 AM1/15/2015 4:21 PM
DatesSigned By DateInsert  1/15/2015 12:00:00 AM1/15/2015 4:21 PM
DatesStart DateInsert   1/15/2015 4:21 PM
TerminationsTermination CommentsInsert   1/15/2015 4:21 PM
TerminationsTermination DateInsert   1/15/2015 4:21 PM
TerminationsTermination Effective DateInsert   1/15/2015 4:21 PM
TerminationsTermination ReasonInsert   1/15/2015 4:21 PM