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WAL-MART PHARMACY 10-5315
CAH371323-00 WEATHERFORD HOSPITAL AUTHORITY
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Covered Entity Details
Entity Name
WEATHERFORD HOSPITAL AUTHORITY
Subdivision Name
WEATHERFORD REGIONAL HOSPITAL
Type
Critical Access Hospital
340B ID
CAH371323-00
Entity Address
3701 E MAIN STREET
WEATHERFORD, OK 73096
Medicare Provider Number
371323
Participating Start Date
5/9/2018
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian Denton, CEO
(580) 772-5551 Ext: 750
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/17/2018
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