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HOMETOWN DRUG COMPANY, LLC
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
HOMETOWN DRUG COMPANY, LLC
Pharmacy Address
307 N BROADWAY ST
POTEAU, OK 74953-3355
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/12/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert Lee Carter, CEO
(918) 635-3309
Contract Pharmacy Representative
Hometown Drug Co.
Jason Carter, Owner/PIC
(918) 647-2349
Signed By Date
7/12/2019
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