340B Drug Pricing Program Database
CLINIC PHARMACY
CAH371325-00 CORDELL MEMORIAL HOSPITAL - information as of 5/15/2025 2:13:25 AM
Covered Entity Details
Entity Name
CORDELL MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371325-00
Entity Address
1220 N GLENN ENGISH
CORDELL, OK 73632
Medicare Provider Number
371325
Participating Start Date
10/1/2019
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
CLINIC PHARMACY
Pharmacy Address
CLINIC PHARMACY OF CORDELL, INC
1213 N GLENN L ENGLISH ST
CORDELL, OK 73632-2009
Pharmacy Comments
Contract Details
Approval Date
7/23/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Melinda K. Laird, CEO/CNO
(580) 832-3339
Contract Pharmacy Representative
Clinic Pharmacy
Chris Johnson, Owner
(580) 832-3714
Signed By Date
7/15/2019
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