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WAL-MART PHARMACY 10-0232
CAH371319-00 COAL COUNTY
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Covered Entity Details
Entity Name
COAL COUNTY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371319-00
Entity Address
6 NORTH COVINGTON
COALGATE, OK 74538
Medicare Provider Number
371319
Participating Start Date
4/1/2019
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0232
Pharmacy Address
1983 S. MISSISSIPPI
ATOKA, OK 74525
Pharmacy Comments
Contract Details
Approval Date
4/9/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Billy D Johnson, Chief Executive Officer
(580) 927-2327 Ext: 272
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/9/2019
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