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WAL-MART PHARMACY 10-0121
CHC10583-00 EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER INC
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Covered Entity Details
Entity Name
EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER INC
Subdivision Name
East Central Oklahoma Family Health Center, Inc.
Type
HRSA-Funded Health Center
340B ID
CHC10583-00
Entity Address
109 S. Main
Wetumka, OK 74883-4015
Grant Number
H80CS10583
Participating Start Date
4/1/2009
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0121
Pharmacy Address
1800 S WOOD DRIVE
OKMULGEE, OK 74447
Pharmacy Comments
Contract Details
Approval Date
1/9/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DONNA DYER, CEO
(405) 452-3151 Ext: 4101
Contract Pharmacy Representative
East Central Oklahoma Family Health Center, Inc,
DONNA DYER, CEO
(405) 452-3151 Ext: 4101
Signed By Date
1/9/2019
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