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D & D PHARMACY
CAH371337-00 EASTERN OKLAHOMA MEDICAL CENTER
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Covered Entity Details
Entity Name
EASTERN OKLAHOMA MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371337-00
Entity Address
105 WALL STREET
POTEAU, OK 74953
Medicare Provider Number
371337
Participating Start Date
4/1/2017
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
D & D PHARMACY
Pharmacy Address
1940 N BROADWAY ST
POTEAU, OK 74953-2638
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Lee Carter, CEO
(918) 635-3309
Contract Pharmacy Representative
D & D Pharmacy
DOUG HORNE, OWNER/PIC
(918) 647-3137
Signed By Date
7/12/2019
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