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CHC06453-00 PUSHMATAHA FAMILY MEDICAL CENTER INC. (Active)
Main Details
Name
PUSHMATAHA FAMILY MEDICAL CENTER INC.
Subdivision Name
PUSHMATAHA FAMILY MEDICAL CENTER
Type
HRSA-Funded Health Center
Site ID
BPS-H80-012572
340B ID
CHC06453-00
Grant Number
H80CS06453
Contacts
Authorizing Official
Pushmataha Family Medical Center
Angela Batton, CEO
(918) 569-4143
Primary Contact
Pushmataha Family Medical Center, Inc.
Alaina Dale Bray, CFO
(918) 569-4143 Ext: 40
Additional Details
Current Program Status
Active
Registration Date
11/2/2017
Participating Start Date
1/1/2018
Participating Approval Date
11/2/2017
Last Recertification Date
2/5/2024
Addresses
Street Address
1020 North Lawson Blvd
CLAYTON, OK 74536-0219
Billing Address
Pushmataha Family Medical Center, Inc.
PO Box 219
Clayton, OK 74536
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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Participated starting 4/1/2012, terminated 4/1/2016. Reinstated 1/1/2018.
11/02/2017
May 2024
May 2024
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