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WAL-MART PHARMACY 10-0607
CAH371325-00 CORDELL MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CORDELL MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371325-00
Entity Address
1220 N GLENN ENGISH
CORDELL, OK 73632
Medicare Provider Number
371325
Participating Start Date
10/1/2019
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0607
Pharmacy Address
923 W 11TH STREET HWY 9
HOBART, OK 73651
Pharmacy Comments
Contract Details
Approval Date
7/23/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Melinda K. Laird, CEO/CNO
(580) 832-3339
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/15/2019
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