340B Drug Pricing Program Database


CAH371320-00 CLEVELAND AREA HOSPITAL (Active) - information as of 4/29/2025 12:35:38 AM

Main Details
CLEVELAND AREA HOSPITAL
Critical Access Hospital
Yes
CAH371320-00
371320


Additional Details
Active
10/5/2021
1/1/2022
10/6/2021
8/23/2024

Contacts

Cleveland Area Hospital
Melva D. Bostik, RN, BSN, RHCNOC
(918) 358-2501 Ext: 4326

Cleveland Area Hospital
Nathan Langford, Financial Analyst
(918) 358-2501

Addresses

1401 W PAWNEE
CLEVELAND, OK 74020

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
Participated starting 4/1/2019, terminated 10/1/2021. Reinstated 1/1/2022.10/06/2021
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
OK200234090A,200234090B1427295872,1801020565,1588160774
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailPALACE DRUGMOORE HEALTH CARE 301 N BROADWAY ST
CLEVELANDOK74020-342104/14/202507/01/2025  04/14/2025
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/14/202507/01/2025  04/14/2025
Contract DetailWAL-MART PHARMACY 10-0207772 N AIRPORT RD
CLEVELANDOK7402004/14/202507/01/2025  04/14/2025
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/14/202507/01/2025  04/14/2025
Contract DetailWALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275604/14/202507/01/2025  04/14/2025
Contract DetailWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616804/14/202507/01/2025  04/14/2025
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
CAH371320-01ChildCAHCLEVELAND AREA HOSPITALLake Area Medical Associates - Primary Care1400 W. PawneeClevelandOKApproved
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification8/23/2023 10:54:45 AM8/23/2024 1:45:30 PM8/23/2024 1:45 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestBostik, Melva D. RN, BSN, CNO Cleveland Area Hospital 9183582501-4326Bostik, Melva D. RN, BSN, RHCNOC Cleveland Area Hospital 9183582501-43268/22/2024 3:11 PM
ContactsSigned ByUpdateProfile Change RequestBostik, Melva D. RN, BSN, CNO Cleveland Area Hospital 9183582501-4326Bostik, Melva D. RN, BSN, RHCNOC Cleveland Area Hospital 9183582501-43268/22/2024 3:11 PM
DetailsLast Recertification DateUpdateRecertification9/5/2022 9:05:30 AM8/23/2023 10:54:45 AM8/23/2023 10:54 AM
DetailsLast Recertification DateUpdateRecertification 9/5/2022 9:05:30 AM9/5/2022 9:05 AM
DetailsStateUpdate ApprovedActive1/1/2022 12:01 AM
DetailsLast Recertification DateUpdateReinstatement8/26/2020 2:51:38 PM 10/6/2021 7:34 AM
DatesLast Date That 340B Drugs PurchasedUpdateReinstatement9/30/2021 12:00:00 AM 10/6/2021 7:34 AM
DatesParticipating Approval DateUpdateReinstatement3/15/2019 2:43:46 PM10/6/2021 7:34:02 AM10/6/2021 7:34 AM
DetailsStateUpdateReinstatementTerminatedApproved10/6/2021 7:34 AM
DatesRegistration DateUpdateReinstatement1/9/2019 6:26:15 PM10/5/2021 4:38:43 PM10/6/2021 7:34 AM
DatesSigned By DateUpdateReinstatement3/15/2019 10:27:16 AM10/5/2021 4:38:51 PM10/6/2021 7:34 AM
DatesStart DateUpdateReinstatement4/1/2019 12:00:00 AM1/1/2022 12:00:00 AM10/6/2021 7:34 AM
TerminationsTermination DateUpdateReinstatement10/1/2021 12:00:00 AM 10/6/2021 7:34 AM
TerminationsTermination Effective DateUpdateReinstatement10/1/2021 12:00:00 AM 10/6/2021 7:34 AM
TerminationsTermination ReasonUpdateReinstatementFailure to recertify 10/6/2021 7:34 AM
DetailsComments PublicInsertReinstatement Participated starting 4/1/2019, terminated 10/1/2021. Reinstated 1/1/2022.10/6/2021 7:27 AM
DetailsStateUpdate To Be TerminatedTerminated10/1/2021 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateRecertification 9/30/2021 12:00:00 AM9/17/2021 7:37 AM
DetailsStateUpdateRecertificationActiveTo Be Terminated9/17/2021 7:37 AM
TerminationsTermination DateUpdateRecertification 10/1/2021 12:00:00 AM9/17/2021 7:37 AM
TerminationsTermination Effective DateUpdateRecertification 10/1/2021 12:00:00 AM9/17/2021 7:37 AM
TerminationsTermination ReasonUpdateRecertification Failure to recertify9/17/2021 7:37 AM
Medicaid BillingNPI: NumberInsertRecertification 14272958728/26/2020 2:51 PM
Medicaid BillingNPI: StateInsertRecertification OK8/26/2020 2:51 PM
Medicaid BillingNPI: NumberInsertRecertification 18010205658/26/2020 2:51 PM
Medicaid BillingNPI: StateInsertRecertification OK8/26/2020 2:51 PM
Medicaid BillingNPI: NumberInsertRecertification 15881607748/26/2020 2:51 PM
Medicaid BillingNPI: StateInsertRecertification OK8/26/2020 2:51 PM
Medicaid BillingNPI: NumberDeleteRecertification1427295872 ( ) 8/26/2020 2:51 PM
DetailsLast Recertification DateUpdateRecertification8/23/2019 12:58:29 PM8/26/2020 2:51:38 PM8/26/2020 2:51 PM
DetailsLast Recertification DateUpdateRecertification 8/23/2019 12:58:29 PM8/23/2019 12:58 PM
DetailsStateUpdate ApprovedActive4/1/2019 12:05 AM
ContactsSigned ByInsertNew Registration Bostik, Melva D. RN, BSN, CNO Cleveland Area Hospital 9183582501-43263/15/2019 2:43 PM
Details340B IDUpdateNew Registration CAH371320-003/15/2019 2:43 PM
DatesParticipating Approval DateUpdateNew Registration 3/15/2019 2:43:46 PM3/15/2019 2:43 PM
DetailsStateUpdateNew RegistrationPendingApproved3/15/2019 2:43 PM
DatesSigned By DateUpdateNew Registration 3/15/2019 10:27:16 AM3/15/2019 2:43 PM
DatesStart DateUpdateNew Registration 4/1/2019 12:00:00 AM3/15/2019 2:43 PM
AddressesMain AddressInsertNew Registration  1401 W PAWNEE CLEVELAND, OK 740201/9/2019 6:26 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/9/2019 6:26 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 200234090A1/9/2019 6:26 PM
Medicaid BillingMedicaid: StateInsertNew Registration OK1/9/2019 6:26 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/9/2019 6:26 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 200234090B1/9/2019 6:26 PM
Medicaid BillingMedicaid: StateInsertNew Registration OK1/9/2019 6:26 PM
Medicaid BillingNPI: NumberInsertNew Registration 14272958721/9/2019 6:26 PM
ContactsAuthorizing OfficialInsertNew Registration Bostik, Melva D. RN, BSN, CNO Cleveland Area Hospital 9183582501-43261/9/2019 6:26 PM
ContactsPrimary ContactInsertNew Registration Langford, Nathan Financial Analyst Cleveland Area Hospital 91835825011/9/2019 6:26 PM
DetailsLast Recertification DateInsertNew Registration  1/9/2019 6:26 PM
DetailsGrant NumberInsertNew Registration  1/9/2019 6:26 PM
Details340B IDInsertNew Registration  1/9/2019 6:26 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  1/9/2019 6:26 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  1/9/2019 6:26 PM
DetailsMedicare Provider NumberInsertNew Registration 3713201/9/2019 6:26 PM
DetailsEntity NameInsertNew Registration CLEVELAND AREA HOSPITAL1/9/2019 6:26 PM
DetailsProgram CodeInsertNew Registration CAH1/9/2019 6:26 PM
DetailsEntity SubnameInsertNew Registration  1/9/2019 6:26 PM
DatesParticipating Approval DateInsertNew Registration  1/9/2019 6:26 PM
DetailsStateInsertNew Registration Pending1/9/2019 6:26 PM
DatesRegistration DateInsertNew Registration 1/9/2019 6:26:15 PM1/9/2019 6:26 PM
DatesSigned By DateInsertNew Registration  1/9/2019 6:26 PM
DatesStart DateInsertNew Registration  1/9/2019 6:26 PM
TerminationsTermination CommentsInsertNew Registration  1/9/2019 6:26 PM
TerminationsTermination DateInsertNew Registration  1/9/2019 6:26 PM
TerminationsTermination Effective DateInsertNew Registration  1/9/2019 6:26 PM
TerminationsTermination ReasonInsertNew Registration  1/9/2019 6:26 PM