340B Drug Pricing Program Database
Walgreens MFC #21373
CAH371311-00 JEFFERSON COUNTY HOSPITAL - information as of 5/6/2025 12:19:30 AM
Covered Entity Details
Entity Name
JEFFERSON COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371311-00
Entity Address
9170 US Hwy 70
INTERSECTION HWY 70 & 81
WAURIKA, OK 73573
Medicare Provider Number
371311
Participating Start Date
1/1/2017
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
Walgreens MFC #21373
Pharmacy Address
4100 Dale Earnhardt Way
200
Northlake, TX 76262
Pharmacy Comments
Contract Details
Approval Date
4/16/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Roger Neal, VP-COO
(580) 606-9169
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2024
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