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WALGREEN CO.
CAH371309-00 PAWHUSKA HOSPITAL INC.
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Covered Entity Details
Entity Name
PAWHUSKA HOSPITAL INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371309-00
Entity Address
1101 E 15th St
PAWHUSKA, OK 74056
Medicare Provider Number
371309
Participating Start Date
1/1/2020
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16556
1611 E. 15TH ST.
TULSA, OK 74120
Pharmacy Comments
Contract Details
Approval Date
7/26/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michael W Hand, CFO
(316) 218-3350
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/26/2018
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