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WAL-MART PHARMACY 10-0151
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
WAL-MART PHARMACY 10-0151
Pharmacy Address
432 S GEORGE NIGH EXPWY
MCALESTER, OK 74501
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Angela Batton, CEO
(918) 569-4143
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2019
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