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ASPCARES
CHC06453-00 PUSHMATAHA FAMILY MEDICAL CENTER INC.
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Covered Entity Details
Entity Name
PUSHMATAHA FAMILY MEDICAL CENTER INC.
Subdivision Name
PUSHMATAHA FAMILY MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CHC06453-00
Entity Address
1020 North Lawson Blvd
CLAYTON, OK 74536-0219
Grant Number
H80CS06453
Participating Start Date
1/1/2018
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
ASPCARES
Pharmacy Address
AMERICAN SPECIALTY PHARMACY, INC.
3405 NW EXPRESSWAY
OKLAHOMA CITY, OK 73112
Pharmacy Comments
Contract Details
Approval Date
1/11/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Angela Batton, CEO
(918) 569-4143
Contract Pharmacy Representative
Elite Analytics Group, Inc
Rex Green, CEO
(469) 899-2293
Signed By Date
1/11/2019
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