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WAL-MART PHARMACY 10-5997
CHC08779-00 COMANCHE COUNTY HOSPITAL AUTHORITY (TRUST)
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Covered Entity Details
Entity Name
COMANCHE COUNTY HOSPITAL AUTHORITY (TRUST)
Subdivision Name
Comanche County Hospital Authority DBA Lawton Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC08779-00
Entity Address
5404 Southwest Lee Boulevard
Lawton, OK 73505
Grant Number
H80CS08779
Participating Start Date
7/1/2009
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5997
Pharmacy Address
9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
7/18/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brent Smith, CEO
(580) 585-5852
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/18/2018
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